Healthcare Provider Details

I. General information

NPI: 1245169549
Provider Name (Legal Business Name): MICHAEL W. NDUNGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7914 GALLOPING CIR
WINDSOR MILL MD
21244-1278
US

IV. Provider business mailing address

7914 GALLOPING CIR
WINDSOR MILL MD
21244-1278
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-6513
  • Fax:
Mailing address:
  • Phone: 443-622-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19750
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: