MEDICARE: ELIE TUEGUEM WABO

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	171M00000X	Case Manager/Care Coordinator		MD

General Provider Information

NPI Number	:	1952252264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIE TUEGUEM WABO

Provider Business Mailing Address
First Line	:	9737 MOUNT PISGAH RD APT 504
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9737 MOUNT PISGAH RD APT 504
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2015
Country	:	US
Telephone Number	:	347-680-3474
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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