Provider Demographics
NPI:1194117846
Name:DJAMPOUOP, ISAAC
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:DJAMPOUOP
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 1:5 SCHUBERT CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6841
Mailing Address - Country:US
Mailing Address - Phone:301-327-6264
Mailing Address - Fax:301-890-2264
Practice Address - Street 1:5 SCHUBERT CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6841
Practice Address - Country:US
Practice Address - Phone:301-327-6264
Practice Address - Fax:301-890-2264
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR152306363LF0000X
DCRN965336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily