Provider Demographics
NPI:1932467081
Name:JOH, ANGELLA M
Entity Type:Individual
Prefix:
First Name:ANGELLA
Middle Name:M
Last Name:JOH
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 1:7845 RIVERDALE RD
Mailing Address - Street 2:APT 103
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4009
Mailing Address - Country:US
Mailing Address - Phone:202-702-3561
Mailing Address - Fax:
Practice Address - Street 1:7845 RIVERDALE RD
Practice Address - Street 2:APT 103
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4009
Practice Address - Country:US
Practice Address - Phone:202-702-3561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide