Provider Demographics
NPI:1740020999
Name:EKANGWO, THIBAUT
Entity type:Individual
Prefix:
First Name:THIBAUT
Middle Name:
Last Name:EKANGWO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 RONALD RD APT 204
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-4470
Mailing Address - Country:US
Mailing Address - Phone:240-467-4631
Mailing Address - Fax:
Practice Address - Street 1:6504 RONALD RD APT 204
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-4470
Practice Address - Country:US
Practice Address - Phone:240-467-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172V00000XOther Service ProvidersCommunity Health Worker