Provider Demographics
NPI:1982210217
Name:MPONDO, MADELEINE L
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:L
Last Name:MPONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HUNTERS GATE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1826
Mailing Address - Country:US
Mailing Address - Phone:240-821-0089
Mailing Address - Fax:
Practice Address - Street 1:16 HUNTERS GATE CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1826
Practice Address - Country:US
Practice Address - Phone:240-821-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00162901Medicaid