Provider Demographics
NPI:1699227884
Name:BESONG, JENET MAGKEH
Entity Type:Individual
Prefix:MS
First Name:JENET
Middle Name:MAGKEH
Last Name:BESONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 POTOMAC CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-1901
Mailing Address - Country:US
Mailing Address - Phone:240-413-1621
Mailing Address - Fax:
Practice Address - Street 1:7500 POTOMAC CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-1901
Practice Address - Country:US
Practice Address - Phone:240-413-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC163WH0200XMedicaid