Provider Demographics
NPI:1750076584
Name:NGOH MBA, DIDACUS
Entity type:Individual
Prefix:MR
First Name:DIDACUS
Middle Name:
Last Name:NGOH MBA
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 1:6300 HEADEN JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1431
Mailing Address - Country:US
Mailing Address - Phone:240-791-9365
Mailing Address - Fax:
Practice Address - Street 1:6300 HEADEN JORDAN AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1431
Practice Address - Country:US
Practice Address - Phone:240-791-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200002597374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide