Provider Demographics
NPI:1720648256
Name:PRIMUS, WOHOMBONG DINGWIA
Entity type:Individual
Prefix:
First Name:WOHOMBONG
Middle Name:DINGWIA
Last Name:PRIMUS
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 1:1608 BRIGHTSEAT RD APT 203
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3762
Mailing Address - Country:US
Mailing Address - Phone:240-714-2371
Mailing Address - Fax:
Practice Address - Street 1:1608 BRIGHTSEAT RD APT 203
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-3762
Practice Address - Country:US
Practice Address - Phone:240-714-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14503374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide