Provider Demographics
NPI:1558138776
Name:GUEGUEM, LIONNEL SIMO
Entity Type:Individual
Prefix:
First Name:LIONNEL
Middle Name:SIMO
Last Name:GUEGUEM
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 1:5311 85TH AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3225
Mailing Address - Country:US
Mailing Address - Phone:202-381-6006
Mailing Address - Fax:
Practice Address - Street 1:5311 85TH AVE APT 12
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3225
Practice Address - Country:US
Practice Address - Phone:202-381-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator