MEDICARE: BEATRICE ESUNG MBONGWE

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	M-152-085-235-883	MD

General Provider Information

NPI Number	:	1417218454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE ESUNG MBONGWE

Provider Business Mailing Address
First Line	:	6411 LANDOVER RD
Second Line	:	APT#202
City	:	CHEVERLY
State	:	MD
Zip	:	20785
Country	:	US
Telephone Number	:	240-604-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 LANDOVER RD
Second Line	:	APT#202
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1407
Country	:	US
Telephone Number	:	240-604-0049
Fax Number	:

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	06/06/2012

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