Provider Demographics
NPI:1053795310
Name:NGATCHA, GILLES YVAN
Entity type:Individual
Prefix:
First Name:GILLES
Middle Name:YVAN
Last Name:NGATCHA
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 1:11616 STEWART LN APT 401
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2463
Mailing Address - Country:US
Mailing Address - Phone:240-708-6310
Mailing Address - Fax:
Practice Address - Street 1:4516 FORT TOTTEN DR NE
Practice Address - Street 2:APT 7
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7523
Practice Address - Country:US
Practice Address - Phone:240-708-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11316374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide