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General NPI Number Information
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NPI Number | 1083575682
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Entity Type | Individual
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Provider Name | JACKSON NGANGA
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Gender | Male
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Dates
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Enumeration Date | 11/21/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 516 GLENWOOD AVE
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City | BALTIMORE
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State | MD
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Zip | 21212-4230
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Country | US
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Telephone | 410-323-9811
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Fax | 410-323-3862
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Provider Business Mailing Address
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Address Line | 8501 CASTLEMILL CIR
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City | NOTTINGHAM
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State | MD
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Zip | 21236-2606
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Country | US
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Telephone | 410-323-9811
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Fax | 443-552-3232
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP43242
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License Number State | MD
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