Healthcare Provider Details

I. General information

NPI: 1417878398
Provider Name (Legal Business Name): ERNEST N AJANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15617 NORUS ST
UPPER MARLBORO MD
20772-8254
US

IV. Provider business mailing address

15617 NORUS ST
UPPER MARLBORO MD
20772-8254
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-5554
  • Fax: 240-460-5554
Mailing address:
  • Phone: 240-460-5554
  • Fax: 240-460-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: