Provider Demographics
NPI:1821875246
Name:NGU, BLAISE FORBI
Entity Type:Individual
Prefix:
First Name:BLAISE
Middle Name:FORBI
Last Name:NGU
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 1:3320 DODGE PARK RD APT 304
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2116
Mailing Address - Country:US
Mailing Address - Phone:214-845-0185
Mailing Address - Fax:
Practice Address - Street 1:3320 DODGE PARK RD APT 304
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2116
Practice Address - Country:US
Practice Address - Phone:214-845-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator