Provider Demographics
NPI:1790554558
Name:AJAH, BERTILLA ATUH
Entity Type:Individual
Prefix:
First Name:BERTILLA ATUH
Middle Name:
Last Name:AJAH
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 1:5702 SIGNET LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3527
Mailing Address - Country:US
Mailing Address - Phone:240-791-9067
Mailing Address - Fax:
Practice Address - Street 1:5702 SIGNET LN
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-3527
Practice Address - Country:US
Practice Address - Phone:240-791-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide