Provider Demographics
NPI:1912267436
Name:MUSONGE, PAUL NDIVE
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:NDIVE
Last Name:MUSONGE
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 1:1025 THOMAS JEFFERSON ST NW
Mailing Address - Street 2:180G
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-5201
Mailing Address - Country:US
Mailing Address - Phone:202-299-1109
Mailing Address - Fax:
Practice Address - Street 1:1025 THOMAS JEFFERSON ST NW
Practice Address - Street 2:180G
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-5201
Practice Address - Country:US
Practice Address - Phone:202-299-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA0986374U00000X
374U00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty