Provider Demographics
NPI:1174874614
Name:FRU, JEPHTHAH TSE
Entity type:Individual
Prefix:
First Name:JEPHTHAH
Middle Name:TSE
Last Name:FRU
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 1:7072 HANOVER PARK DRIVE
Mailing Address - Street 2:APT D1
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770
Mailing Address - Country:US
Mailing Address - Phone:240-351-3039
Mailing Address - Fax:
Practice Address - Street 1:7072 HANOVER PKWY
Practice Address - Street 2:APT, D1
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2072
Practice Address - Country:US
Practice Address - Phone:240-351-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide