Provider Demographics
NPI:1801394002
Name:NDANGOH, MODEST TAH (NP)
Entity Type:Individual
Prefix:
First Name:MODEST
Middle Name:TAH
Last Name:NDANGOH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT RD UNIT 18
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2354
Mailing Address - Country:US
Mailing Address - Phone:301-307-2611
Mailing Address - Fax:301-812-4190
Practice Address - Street 1:6201 GREENBELT RD UNIT 18
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-307-2611
Practice Address - Fax:301-812-4190
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily