MEDICARE: EMMANUEL AMABOH NDITANGWA

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	172V00000X	Community Health Worker		DC

General Provider Information

NPI Number	:	1699620146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL AMABOH NDITANGWA

Provider Business Mailing Address
First Line	:	9875 GOOD LUCK RD APT 4
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3231
Country	:	US
Telephone Number	:	301-675-1615
Fax Number	:

Provider Business Practice Location Address
First Line	:	9875 GOOD LUCK RD APT 4
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3231
Country	:	US
Telephone Number	:	301-675-1615
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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