Provider Demographics
NPI:1467878934
Name:TENDON, ERNEST NGOH
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:NGOH
Last Name:TENDON
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 1:3416 DODGE PARK RD # ABT101
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2035
Mailing Address - Country:US
Mailing Address - Phone:240-467-4037
Mailing Address - Fax:
Practice Address - Street 1:3416 DODGE PARK RD # ABT101
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2035
Practice Address - Country:US
Practice Address - Phone:240-467-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10322390200000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid