Healthcare Provider Details

I. General information

NPI: 1083539217
Provider Name (Legal Business Name): PASTEUR MESUMBE NGWANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 I ST NW STE 473
WASHINGTON DC
20005-3314
US

IV. Provider business mailing address

15029 PINE TOP LN
BURTONSVILLE MD
20866-1318
US

V. Phone/Fax

Practice location:
  • Phone: 202-749-8518
  • Fax:
Mailing address:
  • Phone: 240-564-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: