Provider Demographics
NPI:1801212758
Name:NGUELEUMENI, MARC (HHA)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:NGUELEUMENI
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 JULY DR APT 102
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3606
Mailing Address - Country:US
Mailing Address - Phone:240-704-3891
Mailing Address - Fax:
Practice Address - Street 1:11415 JULY DR APT 102
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3606
Practice Address - Country:US
Practice Address - Phone:240-704-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10225251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA10225Medicare Oscar/Certification