Provider Demographics
NPI:1346791316
Name:ONDEPE, CHARLES IV
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:ONDEPE
Suffix:IV
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 1:3825 64TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1860
Mailing Address - Country:US
Mailing Address - Phone:124-046-7546
Mailing Address - Fax:
Practice Address - Street 1:3825 64TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1860
Practice Address - Country:US
Practice Address - Phone:124-046-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12447390200000X
MDHHA12447374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program