Provider Demographics
NPI:1225644586
Name:DEEN, MADINATU
Entity Type:Individual
Prefix:
First Name:MADINATU
Middle Name:
Last Name:DEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531A GREENBELT RD APT 102
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2323
Mailing Address - Country:US
Mailing Address - Phone:240-938-9591
Mailing Address - Fax:240-965-0096
Practice Address - Street 1:8531A GREENBELT RD APT 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2323
Practice Address - Country:US
Practice Address - Phone:240-938-9591
Practice Address - Fax:240-965-0096
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD500571009298172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver