Individual provider Active NPI

Theresa E Ngwana-Mondoa, MD

  • Pediatrics Physician
  • Rockville, MD
National Provider Identifier
1275523557
Registry record updated Nov 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0057882 Issued in MD
Practice address
9901 Medical Center Dr
Rockville, MD 20850-3357
Phone
(301) 279-6480
NPI assigned
Oct 26, 2005
Last updated
Nov 19, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0057882 MD Primary
Neonatal-Perinatal Medicine Physician 2080N0001X D0057882 MD

Addresses

Primary practice location

9901 Medical Center Dr
Rockville, MD 20850-3357

Mailing address

PO Box 100445
Atlanta, GA 30384-0445
Phone (888) 627-4702

Other identifiers 2

IdentifierTypeStateIssuer
3810012438MedicaidWV
3840018MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181106002185 DC Practitioner - Pediatric Medicine 2668659921 Reassigns benefits to 1 organization
I20241119002558 MD Practitioner - Pediatric Medicine 2668659921 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0057882MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Meritus Medical Center Inc CurrentSince Nov 7, 2024 Accepting new patients
Meritus Medical Center Inc CurrentSince Nov 7, 2024 Accepting new patients
Medstar Medical Group II LLC CurrentSince Sep 8, 2018 Accepting new patients
Medstar Medical Group II LLC CurrentSince Sep 8, 2018 Accepting new patients
MGMC, LLC Current Accepting new patients
Hospital Physician Services, LLLP Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Meritus Medical Center Inc Past Accepting new patients

Locations

3800 Reservoir Rd NW
Washington, DC 20007
Phone (202) 687-2203

7503 Surratts Rd
Clinton, MD 20735
Phone (301) 868-8000

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227052800000",
    "number": "1275523557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100445",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303840445",
            "telephone_number": "888-627-4702",
            "fax_number": "804-253-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9901 MEDICAL CENTER DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503357",
            "telephone_number": "301-279-6480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGWANA-MONDOA",
        "first_name": "THERESA",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-26",
        "last_updated": "2008-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0057882",
            "primary": true
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MD",
            "license": "D0057882",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810012438",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3840018",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.