Provider Demographics
NPI:1043571516
Name:MOLLORO, EJIGAYEHU
Entity Type:Individual
Prefix:
First Name:EJIGAYEHU
Middle Name:
Last Name:MOLLORO
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 1:9002 MANCHESTER RD
Mailing Address - Street 2:#36
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4127
Mailing Address - Country:US
Mailing Address - Phone:301-675-2764
Mailing Address - Fax:
Practice Address - Street 1:9002 MANCHESTER RD
Practice Address - Street 2:#36
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4127
Practice Address - Country:US
Practice Address - Phone:301-675-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide