Provider Demographics
NPI:1124520515
Name:DIBONGE, ANDREW KINGUE (MS)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:KINGUE
Last Name:DIBONGE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23304 RAINBOW ARCH DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-4449
Mailing Address - Country:US
Mailing Address - Phone:240-234-2599
Mailing Address - Fax:
Practice Address - Street 1:23304 RAINBOW ARCH DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:MD
Practice Address - Zip Code:20871-4449
Practice Address - Country:US
Practice Address - Phone:240-234-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide