Provider Demographics
NPI:1104186535
Name:JOSEPH NGWATEZEH, UNKNOWN N
Entity Type:Individual
Prefix:
First Name:UNKNOWN
Middle Name:N
Last Name:JOSEPH NGWATEZEH
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 1:6400 BRAYS ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3524
Mailing Address - Country:US
Mailing Address - Phone:240-701-8099
Mailing Address - Fax:
Practice Address - Street 1:6400 BRAYS ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3524
Practice Address - Country:US
Practice Address - Phone:240-701-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide