Provider Demographics
NPI:1780943365
Name:NOUPEGUE, GERMAINE MELA
Entity type:Individual
Prefix:
First Name:GERMAINE
Middle Name:MELA
Last Name:NOUPEGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 UNIVERSITY BLVD W APT 1403
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3310
Mailing Address - Country:US
Mailing Address - Phone:301-433-2988
Mailing Address - Fax:
Practice Address - Street 1:3305 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-1033
Practice Address - Country:US
Practice Address - Phone:301-433-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-06-08
Deactivation Date:2023-03-15
Deactivation Code:
Reactivation Date:2023-05-22
Provider Licenses
StateLicense IDTaxonomies
172V00000X
DC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker