Provider Demographics
NPI:1639415326
Name:EHIRIM, JUDE CHIBUEZE
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:CHIBUEZE
Last Name:EHIRIM
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 1:9526 MUIRKIRK ROAD
Mailing Address - Street 2:APT 301
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708
Mailing Address - Country:US
Mailing Address - Phone:301-536-6059
Mailing Address - Fax:
Practice Address - Street 1:9526 MUIRKIRK ROAD
Practice Address - Street 2:APT 301
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708
Practice Address - Country:US
Practice Address - Phone:301-536-6059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide