Provider Demographics
NPI:1881016376
Name:ACHALEKE, EMMANUEL
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:ACHALEKE
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 1:5800 ANNAPOLIS RD
Mailing Address - Street 2:APARTMENT 807
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2005
Mailing Address - Country:US
Mailing Address - Phone:240-779-6565
Mailing Address - Fax:
Practice Address - Street 1:5800 ANNAPOLIS ROAD
Practice Address - Street 2:APARTMENT 807
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710
Practice Address - Country:US
Practice Address - Phone:240-779-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10189390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program