Healthcare Provider Details

I. General information

NPI: 1962916973
Provider Name (Legal Business Name): ASUMTA NGUM TUMASANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9704 MOUNT PISGAH RD APT 101
SILVER SPRING MD
20903
US

IV. Provider business mailing address

9708 MOUNT PISGAH RD APT 1
SILVER SPRING MD
20903-2007
US

V. Phone/Fax

Practice location:
  • Phone: 240-618-9949
  • Fax:
Mailing address:
  • Phone: 240-618-9949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: