Provider Demographics
NPI:1043679111
Name:AGOH, CHINEDUM
Entity Type:Individual
Prefix:
First Name:CHINEDUM
Middle Name:
Last Name:AGOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 RIVERDALE RD
Mailing Address - Street 2:APT 301
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5023 RIVERDALE RD
Practice Address - Street 2:APT 301
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1950
Practice Address - Country:US
Practice Address - Phone:301-917-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide