Provider Demographics
NPI:1316708381
Name:FONGANG NGASSA, APOLLINAIRE
Entity type:Individual
Prefix:
First Name:APOLLINAIRE
Middle Name:
Last Name:FONGANG NGASSA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 RIVERDALE RD APT 102
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3922
Mailing Address - Country:US
Mailing Address - Phone:202-300-8611
Mailing Address - Fax:
Practice Address - Street 1:7757 RIVERDALE RD APT 102
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3922
Practice Address - Country:US
Practice Address - Phone:202-300-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker