Provider Demographics
NPI:1912177288
Name:ZAMA, IVAN NGANG (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:NGANG
Last Name:ZAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10319 WESTLAKE DR STE 193
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6403
Mailing Address - Country:US
Mailing Address - Phone:216-502-4311
Mailing Address - Fax:
Practice Address - Street 1:7831 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3338
Practice Address - Country:US
Practice Address - Phone:301-902-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70102207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD048599300Medicaid