Provider Demographics
NPI:1336995000
Name:ACHUNCHO NGWASOH, MOSES
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:ACHUNCHO NGWASOH
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 1:12703 LAYHILL RD APT T1
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3418
Mailing Address - Country:US
Mailing Address - Phone:240-936-5491
Mailing Address - Fax:
Practice Address - Street 1:555 E ST SW APT 405
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-3264
Practice Address - Country:US
Practice Address - Phone:202-247-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant