Provider Demographics
NPI:1003421892
Name:NGOMKAM KAMGA, SOLANGE R
Entity Type:Individual
Prefix:
First Name:SOLANGE
Middle Name:R
Last Name:NGOMKAM KAMGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 TRAVIS CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3213
Mailing Address - Country:US
Mailing Address - Phone:240-618-6692
Mailing Address - Fax:
Practice Address - Street 1:73 TRAVIS CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3213
Practice Address - Country:US
Practice Address - Phone:240-618-6692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00164320Medicaid