Provider Demographics
NPI:1073216701
Name:EROMOSELE, HUMPHERY (PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:HUMPHERY
Middle Name:
Last Name:EROMOSELE
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:MR
Other - First Name:HUMPHERY
Other - Middle Name:
Other - Last Name:EROMOSELE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5434 85TH AVE APT T2
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3117
Mailing Address - Country:US
Mailing Address - Phone:240-230-2731
Mailing Address - Fax:
Practice Address - Street 1:1221 TAYLOR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5617
Practice Address - Country:US
Practice Address - Phone:202-464-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000812393376K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide