Provider Demographics
NPI:1528742855
Name:MBONG, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MBONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MONDRIAN TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3235
Mailing Address - Country:US
Mailing Address - Phone:240-426-7172
Mailing Address - Fax:
Practice Address - Street 1:1029 MONDRIAN TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3235
Practice Address - Country:US
Practice Address - Phone:240-426-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator