Provider Demographics
NPI:1508471129
Name:NDI, ROGER
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:NDI
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 1:5377 QUINCY ST # 1
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1108
Mailing Address - Country:US
Mailing Address - Phone:240-707-5555
Mailing Address - Fax:
Practice Address - Street 1:5377 QUINCY ST # 1
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1108
Practice Address - Country:US
Practice Address - Phone:240-707-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC276647448Medicaid