Provider Demographics
NPI:1881388395
Name:NKEDE, GERMAIN-BLAISE MBELLE
Entity type:Individual
Prefix:
First Name:GERMAIN-BLAISE
Middle Name:MBELLE
Last Name:NKEDE
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 1:1005 WHISTLING DUCK DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7149
Mailing Address - Country:US
Mailing Address - Phone:301-906-1756
Mailing Address - Fax:
Practice Address - Street 1:6401 AMERICA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2357
Practice Address - Country:US
Practice Address - Phone:301-276-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD30065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program