Provider Demographics
NPI:1578211751
Name:NGANGA, MARTIN KAMAU
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:KAMAU
Last Name:NGANGA
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 1:18 CAMPUS BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3245
Mailing Address - Country:US
Mailing Address - Phone:610-613-8552
Mailing Address - Fax:484-727-9378
Practice Address - Street 1:18 CAMPUS BLVD STE 122
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3245
Practice Address - Country:US
Practice Address - Phone:610-613-8552
Practice Address - Fax:484-423-3401
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN311974251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health