MEDICARE: DERICK TEWAN NGU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA10006	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043640519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERICK TEWAN NGU

Provider Business Mailing Address
First Line	:	4605 N CAPITOL ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4605 N CAPITOL ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6723
Country	:	US
Telephone Number	:	202-751-8237
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	11/20/2013

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Directions to “ DERICK TEWAN NGU ” Practice Location

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