Provider Demographics
NPI:1205315843
Name:NKENGATEH, FREDERICK NGU
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:NGU
Last Name:NKENGATEH
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 1:7737 RIVERDALE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3904
Mailing Address - Country:US
Mailing Address - Phone:240-579-8790
Mailing Address - Fax:
Practice Address - Street 1:7737 RIVERDALE RD APT 304
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3904
Practice Address - Country:US
Practice Address - Phone:240-579-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13902374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide