MEDICARE: MOMGOH ROLAND TIFUH

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	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1093534083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOMGOH ROLAND TIFUH

Provider Business Mailing Address
First Line	:	6554 PRINCESS GARDEN PKWY
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3533
Country	:	US
Telephone Number	:	240-305-9701
Fax Number	:

Provider Business Practice Location Address
First Line	:	6554 PRINCESS GARDEN PKWY
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3533
Country	:	US
Telephone Number	:	240-305-9701
Fax Number	:

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

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/23/2024

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Directions to “ MOMGOH ROLAND TIFUH ” Practice Location

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