Healthcare Provider Details

I. General information

NPI: 1982234555
Provider Name (Legal Business Name): COLLINS N NGOH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839B RIVERDALE RD APT B2
RIVERDALE MD
20737-3688
US

IV. Provider business mailing address

1220 12TH ST SE STE G35
WASHINGTON DC
20003-3738
US

V. Phone/Fax

Practice location:
  • Phone: 301-454-9387
  • Fax:
Mailing address:
  • Phone: 202-544-8090
  • Fax: 202-544-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14868
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: