Provider Demographics
NPI:1447509419
Name:AGBORNCHONG, DIANA BESSEM
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:BESSEM
Last Name:AGBORNCHONG
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 1:11605 35TH PL
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2709
Mailing Address - Country:US
Mailing Address - Phone:240-646-2081
Mailing Address - Fax:
Practice Address - Street 1:11605 35TH PL
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2709
Practice Address - Country:US
Practice Address - Phone:240-646-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide