Provider Demographics
NPI:1023550886
Name:WEREGWE, ATAGWE SIMON
Entity type:Individual
Prefix:
First Name:ATAGWE
Middle Name:SIMON
Last Name:WEREGWE
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 1:6229 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2703
Mailing Address - Country:US
Mailing Address - Phone:202-834-7974
Mailing Address - Fax:
Practice Address - Street 1:2041 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-7024
Practice Address - Country:US
Practice Address - Phone:202-547-8540
Practice Address - Fax:202-610-7147
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator