Provider Demographics
NPI:1659920288
Name:NGWAM, GILDAS
Entity Type:Individual
Prefix:
First Name:GILDAS
Middle Name:
Last Name:NGWAM
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 1:4509 DR BEANS LEGACY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6385
Mailing Address - Country:US
Mailing Address - Phone:202-909-0062
Mailing Address - Fax:
Practice Address - Street 1:4509 DR BEANS LEGACY CIR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6385
Practice Address - Country:US
Practice Address - Phone:202-909-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide