Provider Demographics
NPI:1255673661
Name:ANJEH, DIVINE E
Entity Type:Individual
Prefix:MR
First Name:DIVINE
Middle Name:E
Last Name:ANJEH
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 1:10811 SUGAR MAPLE TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1323
Mailing Address - Country:US
Mailing Address - Phone:240-784-6772
Mailing Address - Fax:
Practice Address - Street 1:10811 SUGAR MAPLE TER
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1323
Practice Address - Country:US
Practice Address - Phone:240-784-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide