Provider Demographics
NPI:1902383797
Name:AHUBELEM, CORDELIA
Entity Type:Individual
Prefix:
First Name:CORDELIA
Middle Name:
Last Name:AHUBELEM
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 1:2222 PINEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3363
Mailing Address - Country:US
Mailing Address - Phone:240-460-4473
Mailing Address - Fax:
Practice Address - Street 1:7032 ALASKA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1542
Practice Address - Country:US
Practice Address - Phone:240-460-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00144795374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide