Provider Demographics
NPI:1568095495
Name:CHE, MAC ZORAH AZIGWI
Entity Type:Individual
Prefix:
First Name:MAC ZORAH
Middle Name:AZIGWI
Last Name:CHE
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 1:600 PALMERTON TER
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5900
Mailing Address - Country:US
Mailing Address - Phone:301-658-4595
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:202-723-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14960374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide