Provider Demographics
NPI:1114305190
Name:SOWHO, HUMPHREY
Entity Type:Individual
Prefix:
First Name:HUMPHREY
Middle Name:
Last Name:SOWHO
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 1:6304 CHEETAH CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4339
Mailing Address - Country:US
Mailing Address - Phone:301-423-0535
Mailing Address - Fax:
Practice Address - Street 1:7515 ANNAPOLIS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1740
Practice Address - Country:US
Practice Address - Phone:301-423-0535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA 0419376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide