Healthcare Provider Details

I. General information

NPI: 1073437331
Provider Name (Legal Business Name): ULRICH VIANNEY AFANE MEKOULOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 EASTERN AVE NW STE 209
WASHINGTON DC
20012-1333
US

IV. Provider business mailing address

3990 WARNER AVE APT B8
LANDOVER HILLS MD
20784-2013
US

V. Phone/Fax

Practice location:
  • Phone: 202-810-5454
  • Fax:
Mailing address:
  • Phone: 781-535-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: