MEDICARE: MR. BASIL TEGHEN NDUM RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	0001301762	VA

General Provider Information

NPI Number	:	1063225142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BASIL TEGHEN NDUM RN

Provider Business Mailing Address
First Line	:	3301 RICHMOND HWY
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-3044
Country	:	US
Telephone Number	:	240-872-6598
Fax Number	:

Provider Business Practice Location Address
First Line	:	9105 JOUSTING LN
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-4388
Country	:	US
Telephone Number	:	240-872-6598
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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