Provider Demographics
NPI:1023378189
Name:NDAMFOMBAD, ANDREW MBAMUZANG
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MBAMUZANG
Last Name:NDAMFOMBAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 RIVERDALE RD APT 202
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3935
Mailing Address - Country:US
Mailing Address - Phone:240-704-1260
Mailing Address - Fax:
Practice Address - Street 1:7775 RIVERDALE RD APT 202
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3935
Practice Address - Country:US
Practice Address - Phone:240-704-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide