Provider Demographics
NPI:1861739518
Name:NGONGMON, PASCAL (MD)
Entity type:Individual
Prefix:DR
First Name:PASCAL
Middle Name:
Last Name:NGONGMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 HARBOR CENTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2847
Mailing Address - Country:US
Mailing Address - Phone:703-955-5355
Mailing Address - Fax:
Practice Address - Street 1:13000 HARBOR CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2847
Practice Address - Country:US
Practice Address - Phone:703-955-5355
Practice Address - Fax:703-955-5348
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262652207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861739518Medicaid