Provider Demographics
NPI:1396412243
Name:ATIANJOH, FIDELIS EGHOATEH (PMHNP)
Entity Type:Individual
Prefix:DR
First Name:FIDELIS
Middle Name:EGHOATEH
Last Name:ATIANJOH
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MERCANTILE LN STE 200C
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4309
Mailing Address - Country:US
Mailing Address - Phone:301-332-8886
Mailing Address - Fax:
Practice Address - Street 1:1401 MERCANTILE LN STE 200C
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4309
Practice Address - Country:US
Practice Address - Phone:301-332-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN221785363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty