Healthcare Provider Details

I. General information

NPI: 1912177288
Provider Name (Legal Business Name): IVAN NGANG ZAMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7831 BELLE POINT DR
GREENBELT MD
20770-3338
US

IV. Provider business mailing address

10319 WESTLAKE DR STE 193
BETHESDA MD
20817-6403
US

V. Phone/Fax

Practice location:
  • Phone: 301-902-0664
  • Fax:
Mailing address:
  • Phone: 216-502-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberD70102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: