Provider Demographics
NPI:1679942635
Name:ATINGATANG, CLETUS ASOGO (PA - C)
Entity Type:Individual
Prefix:
First Name:CLETUS
Middle Name:ASOGO
Last Name:ATINGATANG
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CYNTHIAS PL APT 302
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7435
Mailing Address - Country:US
Mailing Address - Phone:301-793-1802
Mailing Address - Fax:
Practice Address - Street 1:1812 METZEROTT RD APT 46
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5171
Practice Address - Country:US
Practice Address - Phone:301-793-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110008420363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical