Provider Demographics
NPI:1275140097
Name:KOSKEI, JUSTICE KIPLANGAT (CCHW)
Entity Type:Individual
Prefix:
First Name:JUSTICE
Middle Name:KIPLANGAT
Last Name:KOSKEI
Suffix:
Gender:M
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S HANOVER ST # SA-155
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1233
Mailing Address - Country:US
Mailing Address - Phone:410-980-9889
Mailing Address - Fax:410-350-8107
Practice Address - Street 1:3001 S HANOVER ST # SA-155
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1233
Practice Address - Country:US
Practice Address - Phone:410-980-9889
Practice Address - Fax:410-350-8107
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1275140097OtherCENTERS FOR MEDICARE & MEDICAID SERVICES