Provider Demographics
NPI:1659717338
Name:AGHA, THEODORE
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:
Last Name:AGHA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:THEODORE
Other - Middle Name:
Other - Last Name:AGHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3205 TOLEDO PL
Mailing Address - Street 2:APT T4
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4117
Mailing Address - Country:US
Mailing Address - Phone:240-413-0886
Mailing Address - Fax:
Practice Address - Street 1:3205 TOLEDO PL
Practice Address - Street 2:APT T4
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4117
Practice Address - Country:US
Practice Address - Phone:240-413-0886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHH4846374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide