Provider Demographics
NPI:1861865156
Name:KUM, MARCEL
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:KUM
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 1:2400 QUEENS CHAPEL RD
Mailing Address - Street 2:APT 6
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3616
Mailing Address - Country:US
Mailing Address - Phone:301-683-4905
Mailing Address - Fax:
Practice Address - Street 1:2400 QUEENS CHAPEL RD
Practice Address - Street 2:APT 6
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3616
Practice Address - Country:US
Practice Address - Phone:301-683-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA 11532374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide