Basic Information
| Provider Information | |||||||||
| NPI: | 1831689124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOENG | ||||||||
| FirstName: | LETUMILE | ||||||||
| MiddleName: | RODGERS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2041 GEORGIA AVE HOWARD UNIVERSITY HOSPITAL NW 5C-26 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028651924 | ||||||||
| FaxNumber: | 2028657199 | ||||||||
| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE HOWARD UNIVERSITY HOSPITAL NW 5C-26 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028651924 | ||||||||
| FaxNumber: | 2028657199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2018 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/09/2019 | ||||||||
| NPIReactivationDate: | 01/31/2019 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.