Provider Demographics
NPI:1083965214
Name:BINGAN, EMMANUEL C
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:C
Last Name:BINGAN
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 1:3515 SHEFFIELD MANOR TER
Mailing Address - Street 2:APT 202
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7276
Mailing Address - Country:US
Mailing Address - Phone:202-291-7226
Mailing Address - Fax:202-291-4009
Practice Address - Street 1:439 ONEIDA PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2150
Practice Address - Country:US
Practice Address - Phone:202-291-7226
Practice Address - Fax:202-291-4009
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036061400Medicaid