Provider Demographics
NPI:1417599895
Name:NANJOH, ROGER
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:NANJOH
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 1:5711 SARVIS AVE # 608
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1394
Mailing Address - Country:US
Mailing Address - Phone:301-277-4337
Mailing Address - Fax:301-277-4335
Practice Address - Street 1:5711 SARVIS AVE # 608
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1394
Practice Address - Country:US
Practice Address - Phone:301-277-4337
Practice Address - Fax:301-277-4335
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA0000811600374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide