Healthcare Provider Details

I. General information

NPI: 1063357879
Provider Name (Legal Business Name): EUGENE M NGUNDU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ARTESIAN LN
BOWIE MD
20716-3802
US

IV. Provider business mailing address

2410 ARTESIAN LN
BOWIE MD
20716-3802
US

V. Phone/Fax

Practice location:
  • Phone: 214-892-8664
  • Fax:
Mailing address:
  • Phone: 214-892-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: