Provider Demographics
NPI:1093054496
Name:NDIVE, EKO
Entity Type:Individual
Prefix:
First Name:EKO
Middle Name:
Last Name:NDIVE
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 1:7709 ORA CT
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2478
Mailing Address - Country:US
Mailing Address - Phone:240-898-7801
Mailing Address - Fax:
Practice Address - Street 1:7709 ORA CT
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2478
Practice Address - Country:US
Practice Address - Phone:240-898-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide