Provider Demographics
NPI:1912341041
Name:EWUNKEM, ROBERTO EKANGWO (HOME HEALTH)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:EKANGWO
Last Name:EWUNKEM
Suffix:
Gender:M
Credentials:HOME HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6207 64TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2937
Mailing Address - Country:US
Mailing Address - Phone:240-237-5466
Mailing Address - Fax:
Practice Address - Street 1:6207 64TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2937
Practice Address - Country:US
Practice Address - Phone:240-237-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health