1073871778 NPI number — MR. NEMBO ANDREAS MENKEMTEBA I HHA

Table of content: MR. NEMBO ANDREAS MENKEMTEBA I HHA (NPI 1073871778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073871778 NPI number — MR. NEMBO ANDREAS MENKEMTEBA I HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENKEMTEBA
Provider First Name:
NEMBO
Provider Middle Name:
ANDREAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
HHA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NA
Provider Other First Name:
NA
Provider Other Middle Name:
NA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073871778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4428 68TH PL
Provider Second Line Business Mailing Address:
APT C3
Provider Business Mailing Address City Name:
HYATTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20784-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-838-6015
Provider Business Mailing Address Fax Number:
202-529-6570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4428 68TH PLACE
Provider Second Line Business Practice Location Address:
APT C3
Provider Business Practice Location Address City Name:
HYATSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20784-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-838-6015
Provider Business Practice Location Address Fax Number:
202-529-6570
Provider Enumeration Date:
05/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , with the licence number:  M-525-626-027-030 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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