Provider Demographics
NPI:1053672824
Name:NGALE, CARLSON MAGUNDA
Entity Type:Individual
Prefix:
First Name:CARLSON
Middle Name:MAGUNDA
Last Name:NGALE
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 1:6711 LONGRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3740
Mailing Address - Country:US
Mailing Address - Phone:240-505-8981
Mailing Address - Fax:
Practice Address - Street 1:6711 LONGRIDGE DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3740
Practice Address - Country:US
Practice Address - Phone:240-505-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN240108018947374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide