Provider Demographics
NPI:1659154730
Name:NDE, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:NDE
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 1:15115 JOPPA PL
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7232
Mailing Address - Country:US
Mailing Address - Phone:817-480-7068
Mailing Address - Fax:
Practice Address - Street 1:15115 JOPPA PL
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7232
Practice Address - Country:US
Practice Address - Phone:817-480-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator