Provider Demographics
NPI:1700220316
Name:MBANG AKOULONG, MAX FELICITE
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:FELICITE
Last Name:MBANG AKOULONG
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 1:11240 EVANS TRL APT 103
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3923
Mailing Address - Country:US
Mailing Address - Phone:202-545-0935
Mailing Address - Fax:202-545-0176
Practice Address - Street 1:11240 EVANS TRL APT 103
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3923
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:202-545-0176
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide