Provider Demographics
NPI:1205405867
Name:FON MUDOH, REMOUS
Entity Type:Individual
Prefix:
First Name:REMOUS
Middle Name:
Last Name:FON MUDOH
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 1:1125 IVY CLUB LN APT 20785
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4533
Mailing Address - Country:US
Mailing Address - Phone:240-764-9913
Mailing Address - Fax:
Practice Address - Street 1:1125 IVY CLUB LN APT 20785
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4533
Practice Address - Country:US
Practice Address - Phone:240-764-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT01031323747P1801X
DCHHA200002849374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant