Provider Demographics
NPI:1033779301
Name:NAGOU, NAMDIOGOU
Entity Type:Individual
Prefix:
First Name:NAMDIOGOU
Middle Name:
Last Name:NAGOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 BETTY LINTON LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7358
Mailing Address - Country:US
Mailing Address - Phone:240-464-5866
Mailing Address - Fax:301-740-6422
Practice Address - Street 1:6395 BETTY LINTON LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7358
Practice Address - Country:US
Practice Address - Phone:240-464-5866
Practice Address - Fax:301-740-6422
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4373251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health