Healthcare Provider Details

I. General information

NPI: 1528772779
Provider Name (Legal Business Name): COMFORT NGWECHI MBONEFOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 GOOD HOPE RD SE
WASHINGTON DC
20020-5615
US

IV. Provider business mailing address

9632 GREENEL RD
DAMASCUS MD
20872-2396
US

V. Phone/Fax

Practice location:
  • Phone: 202-796-5000
  • Fax:
Mailing address:
  • Phone: 804-888-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: