Individual
MR. ETIENNE T NGOUMGNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C MHS MSC
Contact information
Practice address
821 N EUTAW ST, SUITE 103, BALTIMORE, MD 21201-4648
(410) 225-8760
Mailing address
821 N EUTAW ST, SUITE 103, BALTIMORE, MD 21201-4648
(410) 225-8760
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C0002500
MD
363AM0700X
Medical Physician Assistant
Primary
C0002500
MD
Other
Enumeration date
01/08/2009
Last updated
07/08/2010
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