Provider Demographics
NPI:1760979835
Name:ZELLER, LUDMILLA
Entity Type:Individual
Prefix:
First Name:LUDMILLA
Middle Name:
Last Name:ZELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 MCKENSTRY DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1151
Mailing Address - Country:US
Mailing Address - Phone:301-760-8034
Mailing Address - Fax:
Practice Address - Street 1:2001 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-5828
Practice Address - Country:US
Practice Address - Phone:301-760-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDZ460560398313374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA00152033OtherCNA