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NPI Code Detail

MEDICARE: RHODRI BONGAM CSW

MEDICARE: RHODRI BONGAM CSW
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1639433493
Entity Type Code : Individual
Provider Name (Legal Business Name) : RHODRI BONGAM CSW
Provider Business Mailing Address
First Line : 2934 VISTA ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-2636
Country : US
Telephone Number : 202-545-0935
Fax Number :
Provider Business Practice Location Address
First Line : 2934 VISTA ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-2636
Country : US
Telephone Number : 202-545-0935
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2012
Last Update Date : 10/02/2023

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Directions to “ RHODRI BONGAM CSW” Practice Location

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