Provider Demographics
NPI:1720429368
Name:SONGWE, GWENDOLINE Z (OD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLINE
Middle Name:Z
Last Name:SONGWE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7295 FLAXPOOL CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1772
Mailing Address - Country:US
Mailing Address - Phone:301-213-1277
Mailing Address - Fax:
Practice Address - Street 1:1040 ANNAPOLIS MALL
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3483
Practice Address - Country:US
Practice Address - Phone:410-266-6003
Practice Address - Fax:410-266-5437
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD46-3137857OtherTIN