Provider Demographics
NPI:1598242075
Name:ANDONG, MAXWELL ENEIGHO SR (HHA)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:ENEIGHO
Last Name:ANDONG
Suffix:SR
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:MAXWELL
Other - Middle Name:ENEIGHO
Other - Last Name:ANDONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HHA
Mailing Address - Street 1:5811 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2921
Mailing Address - Country:US
Mailing Address - Phone:202-320-0812
Mailing Address - Fax:
Practice Address - Street 1:5811 84TH AVE
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-2921
Practice Address - Country:US
Practice Address - Phone:202-320-0812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA13822374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide