Provider Demographics
NPI:1134763261
Name:MBOUMA, MARGUERITE MARIE (RN)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MARIE
Last Name:MBOUMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 TERRACE DR APT 111
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7809
Mailing Address - Country:US
Mailing Address - Phone:301-928-8242
Mailing Address - Fax:
Practice Address - Street 1:2809 TERRACE DR APT 111
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7809
Practice Address - Country:US
Practice Address - Phone:301-928-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty