Provider Demographics
NPI:1518842574
Name:PAGANG NGOUNOU, MARCELIN
Entity type:Individual
Prefix:
First Name:MARCELIN
Middle Name:
Last Name:PAGANG NGOUNOU
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 1:13906 BRIARWOOD DR APT 2313
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1334
Mailing Address - Country:US
Mailing Address - Phone:240-351-7672
Mailing Address - Fax:
Practice Address - Street 1:13906 BRIARWOOD DR APT 2313
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1334
Practice Address - Country:US
Practice Address - Phone:240-351-7672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHHA200002830374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide