1104392893 NPI number — EMEASONG FLORENCE ATEM EKOKOBE

Table of content: EMEASONG FLORENCE ATEM EKOKOBE (NPI 1104392893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104392893 NPI number — EMEASONG FLORENCE ATEM EKOKOBE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATEM EKOKOBE
Provider First Name:
EMEASONG FLORENCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1104392893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6521 GREENFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-3556
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-615-6466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 18TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20018-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-529-6510
Provider Business Practice Location Address Fax Number:
202-529-6570
Provider Enumeration Date:
10/19/2018

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:  HHA14044 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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