Individual
BLAISE NGONGBAN MOFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 WARFIELD DR APT 1094, LANDOVER, MD 20785-4785
(124) 081-7629
Mailing address
76 OLD ENTERPRISE RD, UPPER MARLBORO, MD 20774-1648
(240) 817-6297
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/19/2018
Last updated
07/18/2023
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