Provider Demographics
NPI:1972867182
Name:AHAGHOTU, EBERE MERCY
Entity Type:Individual
Prefix:
First Name:EBERE
Middle Name:MERCY
Last Name:AHAGHOTU
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 1:7600 FONTAINEBLEAU DR
Mailing Address - Street 2:APT 204
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3841
Mailing Address - Country:US
Mailing Address - Phone:240-381-5932
Mailing Address - Fax:
Practice Address - Street 1:7600 FONTAINEBLEAU DR
Practice Address - Street 2:APT 204
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3841
Practice Address - Country:US
Practice Address - Phone:240-381-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide