Provider Demographics
NPI:1053820308
Name:ESUNGE, ALICE ASONG
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:ASONG
Last Name:ESUNGE
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 1:14419 DOLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3219
Mailing Address - Country:US
Mailing Address - Phone:301-408-8684
Mailing Address - Fax:
Practice Address - Street 1:14419 DOLBROOK LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3219
Practice Address - Country:US
Practice Address - Phone:301-408-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1413102471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography