Provider Demographics
NPI:1164265005
Name:LEGEJUH AJONG, CLIFFORD (CA)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:LEGEJUH AJONG
Suffix:
Gender:M
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 UTICA PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2412
Mailing Address - Country:US
Mailing Address - Phone:240-946-0986
Mailing Address - Fax:
Practice Address - Street 1:1626 MARION BARRY AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4706
Practice Address - Country:US
Practice Address - Phone:202-248-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator