Provider Demographics
NPI:1982157533
Name:NDEMAZEAH, ELVIS
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:NDEMAZEAH
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 1:4004 ROMSEY DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2810
Mailing Address - Country:US
Mailing Address - Phone:240-667-6004
Mailing Address - Fax:
Practice Address - Street 1:5620 WHITFIELD CHAPEL RD
Practice Address - Street 2:APT 101
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2548
Practice Address - Country:US
Practice Address - Phone:240-667-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29632183500000X
DCHHA12304374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No374U00000XNursing Service Related ProvidersHome Health Aide