Provider Demographics
NPI:1447753207
Name:DAMADO, ADJO ATSOUPI AGOSSI (NP)
Entity Type:Individual
Prefix:MS
First Name:ADJO
Middle Name:ATSOUPI AGOSSI
Last Name:DAMADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 MANCHESTER RD APT 4
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4131
Mailing Address - Country:US
Mailing Address - Phone:301-728-8720
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE STE 106
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2106
Practice Address - Country:US
Practice Address - Phone:202-529-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1030016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily