Provider Demographics
NPI:1194336941
Name:CHONGONG, PHOEBE VUWANSI (NP)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:VUWANSI
Last Name:CHONGONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 CRYSTAL BROOK CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6687
Mailing Address - Country:US
Mailing Address - Phone:240-271-5078
Mailing Address - Fax:
Practice Address - Street 1:10300 CRYSTAL BROOK CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6687
Practice Address - Country:US
Practice Address - Phone:240-271-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193796363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty