Provider Demographics
NPI:1083483986
Name:NDIFON, ELMOND ECHAUKIAN
Entity Type:Individual
Prefix:
First Name:ELMOND
Middle Name:ECHAUKIAN
Last Name:NDIFON
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 1:1013 ANDEAN GOOSE WAY UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7129
Mailing Address - Country:US
Mailing Address - Phone:240-838-4769
Mailing Address - Fax:
Practice Address - Street 1:1013 ANDEAN GOOSE WAY UPPR MARLBORO
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7129
Practice Address - Country:US
Practice Address - Phone:240-838-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator