Provider Demographics
NPI:1700434073
Name:BENJAMIN, ADELE ROVE
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:ROVE
Last Name:BENJAMIN
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 1:3368 CHILLUM RD APT 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1146
Mailing Address - Country:US
Mailing Address - Phone:240-264-9056
Mailing Address - Fax:
Practice Address - Street 1:900 VARNEY ST SE APT 221
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4315
Practice Address - Country:US
Practice Address - Phone:202-563-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00001600873747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant