Provider Demographics
NPI:1720777642
Name:KOMETA, ELVIS NDENGE
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:NDENGE
Last Name:KOMETA
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 1:14912 DOVEHEART LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3079
Mailing Address - Country:US
Mailing Address - Phone:301-979-0135
Mailing Address - Fax:
Practice Address - Street 1:5510 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2320
Practice Address - Country:US
Practice Address - Phone:703-843-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health