Provider Demographics
NPI:1720974645
Name:NNAH, EJIKEMEUWA NKEMAKONAM
Entity type:Individual
Prefix:
First Name:EJIKEMEUWA
Middle Name:NKEMAKONAM
Last Name:NNAH
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 1:3220 RIDGEWAY PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1021
Mailing Address - Country:US
Mailing Address - Phone:443-470-2311
Mailing Address - Fax:
Practice Address - Street 1:3220 RIDGEWAY PL
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1021
Practice Address - Country:US
Practice Address - Phone:443-470-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care