Provider Demographics
NPI:1992345714
Name:NDUNGU, HERMAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:NDUNGU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 TODKILL TRCE
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-3430
Mailing Address - Country:US
Mailing Address - Phone:443-356-1494
Mailing Address - Fax:
Practice Address - Street 1:1030 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2322
Practice Address - Country:US
Practice Address - Phone:410-809-2875
Practice Address - Fax:717-545-5491
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190177363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health