MEDICARE: MRS. NGONACK JOAN NGEMBUS MD

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	207R00000X	Internal Medicine Physician	D0103106	MD

General Provider Information

NPI Number	:	1891436325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NGONACK JOAN NGEMBUS MD

Provider Business Mailing Address
First Line	:	14314 OLD MARLBORO PIKE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2840
Country	:	US
Telephone Number	:	301-627-3500
Fax Number	:	833-559-0865

Provider Business Practice Location Address
First Line	:	14314 OLD MARLBORO PIKE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2840
Country	:	US
Telephone Number	:	301-627-3500
Fax Number	:

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	12/11/2025

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