MEDICARE: ASUMTA NGUM TUMASANG

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	103TH0100X	Health Service Psychologist
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1962916973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASUMTA NGUM TUMASANG

Provider Business Mailing Address
First Line	:	9708 MOUNT PISGAH RD APT 1
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-2007
Country	:	US
Telephone Number	:	240-618-9949
Fax Number	:

Provider Business Practice Location Address
First Line	:	9704 MOUNT PISGAH RD APT 101
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903
Country	:	US
Telephone Number	:	240-618-9949
Fax Number	:

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

Provider Enumeration Date	:	11/29/2017
Last Update Date	:	06/05/2018

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