Provider Demographics
NPI:1477805422
Name:ALLEGIS HEALTHCARE, INC
Entity Type:Organization
Organization Name:ALLEGIS HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOUDIRATOU
Authorized Official - Middle Name:
Authorized Official - Last Name:RADJI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-272-4267
Mailing Address - Street 1:6201 GREENBELT ROAD
Mailing Address - Street 2:SUITE M-18
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4250
Mailing Address - Country:US
Mailing Address - Phone:301-272-4267
Mailing Address - Fax:301-560-5557
Practice Address - Street 1:6201 GREENBELT RD STE M18
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2333
Practice Address - Country:US
Practice Address - Phone:301-272-4267
Practice Address - Fax:301-560-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156395363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334439800Medicaid