Provider Demographics
NPI:1518204171
Name:BESONG, JOSEPH OBEN
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:OBEN
Last Name:BESONG
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 1:11200 LOCKWOOD DR
Mailing Address - Street 2:APT 705
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4551
Mailing Address - Country:US
Mailing Address - Phone:240-704-3591
Mailing Address - Fax:301-933-2007
Practice Address - Street 1:11200 LOCKWOOD DR
Practice Address - Street 2:APT 705
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4551
Practice Address - Country:US
Practice Address - Phone:240-704-3591
Practice Address - Fax:301-933-2007
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC252441650790101Y00000X, 174H00000X, 251E00000X, 253Z00000X, 302R00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No174H00000XOther Service ProvidersHealth Educator
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization