Healthcare Provider Details

I. General information

NPI: 1174017123
Provider Name (Legal Business Name): NJODZEKA VENATIUS NGONG DNP,CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N 4TH ST
OAKLAND MD
21550-1375
US

IV. Provider business mailing address

302 N 4TH ST
OAKLAND MD
21550-1102
US

V. Phone/Fax

Practice location:
  • Phone: 301-533-4000
  • Fax:
Mailing address:
  • Phone: 281-413-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAC002337
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024183237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: