Provider Demographics
NPI:1831471408
Name:NGOLE, SAMUEL KANDE
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:KANDE
Last Name:NGOLE
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 1:608 BURNT MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4506
Mailing Address - Country:US
Mailing Address - Phone:301-326-1003
Mailing Address - Fax:
Practice Address - Street 1:608 BURNT MILLS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4506
Practice Address - Country:US
Practice Address - Phone:301-254-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343800000X
DCRN1015291374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No374U00000XNursing Service Related ProvidersHome Health Aide