Provider Demographics
NPI:1205195161
Name:ASONGMO, ERNEST ASONGTIA
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:ASONGTIA
Last Name:ASONGMO
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 1:5803 CHERRYWOOD TER APT 304
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-5224
Mailing Address - Country:US
Mailing Address - Phone:202-568-2348
Mailing Address - Fax:
Practice Address - Street 1:5803 CHERRYWOOD TER APT 304
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-5224
Practice Address - Country:US
Practice Address - Phone:202-568-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA252234072883374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide