Provider Demographics
NPI:1720827090
Name:ATABONGKENG, AGENDIA MATHEW
Entity type:Individual
Prefix:
First Name:AGENDIA MATHEW
Middle Name:
Last Name:ATABONGKENG
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 1:1405 CANADIEN GEESE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7062
Mailing Address - Country:US
Mailing Address - Phone:202-455-7051
Mailing Address - Fax:
Practice Address - Street 1:1405 CANADIEN GEESE CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7062
Practice Address - Country:US
Practice Address - Phone:202-455-7051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide