Healthcare Provider Details

I. General information

NPI: 1518204171
Provider Name (Legal Business Name): JOSEPH OBEN BESONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11540 LOCKWOOD DR APT B2
SILVER SPRING MD
20904-2424
US

IV. Provider business mailing address

11540 LOCKWOOD DR APT B2
SILVER SPRING MD
20904-2424
US

V. Phone/Fax

Practice location:
  • Phone: 240-704-3591
  • Fax: 301-933-2007
Mailing address:
  • Phone: 240-704-3591
  • Fax: 301-933-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number252441650790
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: