Provider Demographics
NPI:1417643750
Name:MUTAH, AZOH SEVEDZEM
Entity Type:Individual
Prefix:
First Name:AZOH
Middle Name:SEVEDZEM
Last Name:MUTAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 LANDOVER RD APT 203
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1419
Mailing Address - Country:US
Mailing Address - Phone:240-940-7206
Mailing Address - Fax:
Practice Address - Street 1:1615 RHODE ISLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1802
Practice Address - Country:US
Practice Address - Phone:202-832-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator