Provider Demographics
NPI:1942568548
Name:KOGE, ISAAC MESUMBE
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:MESUMBE
Last Name:KOGE
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 1:7803 WENDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5417
Mailing Address - Country:US
Mailing Address - Phone:240-478-0009
Mailing Address - Fax:
Practice Address - Street 1:7803 WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5417
Practice Address - Country:US
Practice Address - Phone:240-478-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide