Active NPI
Matthew Patrick Momoh
- Exclusive Provider Organization
- Upper Marlboro, MD
National Provider Identifier
1366874570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exclusive Provider Organization
- License
- 000119
- Practice address
- 216 Prenton St
Upper Marlboro, MD 20774-1534 - Phone
- (240) 550-9972
- NPI assigned
- Jul 30, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exclusive Provider Organization | 302F00000X | 000119 | DC | Primary |
Addresses
Primary practice location
216 Prenton St
Upper Marlboro, MD 20774-1534
Mailing address
216 Prenton St
Upper Marlboro, MD 20774-1534
Phone (240) 550-9972
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000119 | DC | MD | Exclusive Provider Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375142400000",
"number": "1366874570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 PRENTON ST",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741534",
"telephone_number": "240-550-9972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 PRENTON ST",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207741534",
"telephone_number": "240-550-9972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOMOH",
"first_name": "MATTHEW",
"middle_name": "PATRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-30",
"last_updated": "2013-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "302F00000X",
"taxonomy_group": "",
"desc": "Exclusive Provider Organization",
"state": "DC",
"license": "000119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.