MEDICARE: LUM MERCY MAXIMUANGU NP

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	363LA2100X	Acute Care Nurse Practitioner	0000123	DE
2	363LA2100X	Acute Care Nurse Practitioner	R150156	MD

General Provider Information

NPI Number	:	1942540083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUM MERCY MAXIMUANGU NP

Provider Business Mailing Address
First Line	:	11303 AMHERST AVE STE 2
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4600
Country	:	US
Telephone Number	:	240-604-2949
Fax Number	:	410-609-5551

Provider Business Practice Location Address
First Line	:	11303 AMHERST AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4600
Country	:	US
Telephone Number	:	240-604-2949
Fax Number	:	410-609-5551

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

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	06/16/2026

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