Provider Demographics
NPI:1255680807
Name:NTEZEH, EDMOND AGENDIA
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:AGENDIA
Last Name:NTEZEH
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 1:6525 LANDOVER RD APT 202
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1427
Mailing Address - Country:US
Mailing Address - Phone:240-693-7159
Mailing Address - Fax:
Practice Address - Street 1:6525 LANDOVER RD APT 202
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1427
Practice Address - Country:US
Practice Address - Phone:240-693-7159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide