Provider Demographics
NPI:1447514187
Name:NDAMUKONG, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:NDAMUKONG
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 1:1731 BUNKER HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3026
Mailing Address - Country:US
Mailing Address - Phone:202-635-6133
Mailing Address - Fax:202-635-5780
Practice Address - Street 1:12008 CASTLE PINES LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3183
Practice Address - Country:US
Practice Address - Phone:202-258-5671
Practice Address - Fax:240-607-6760
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN963469376G00000X
174H00000X
MDR149775363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No174H00000XOther Service ProvidersHealth Educator