Provider Demographics
NPI:1851661342
Name:TAKOL, NCHEM RUDOLF
Entity Type:Individual
Prefix:MR
First Name:NCHEM
Middle Name:RUDOLF
Last Name:TAKOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW CASE MANAGER
Mailing Address - Street 1:2101 WHITE FOX DR STE 323
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2619
Mailing Address - Country:US
Mailing Address - Phone:202-427-6357
Mailing Address - Fax:220-723-3065
Practice Address - Street 1:2811 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3865
Practice Address - Country:US
Practice Address - Phone:202-894-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide