Healthcare Provider Details

I. General information

NPI: 1386333888
Provider Name (Legal Business Name): GILBERT EYONG POSTGRADUATE DEGREE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-5732
US

IV. Provider business mailing address

3327 TEAGARDEN CIR
SILVER SPRING MD
20904-7527
US

V. Phone/Fax

Practice location:
  • Phone: 202-563-7632
  • Fax:
Mailing address:
  • Phone: 240-476-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: