MEDICARE: EDMOND AGENDIA NTEZEH

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	374U00000X	Home Health Aide
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255680807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMOND AGENDIA NTEZEH

Provider Business Mailing Address
First Line	:	6525 LANDOVER RD APT 202
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1427
Country	:	US
Telephone Number	:	240-693-7159
Fax Number	:

Provider Business Practice Location Address
First Line	:	6525 LANDOVER RD APT 202
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1427
Country	:	US
Telephone Number	:	240-693-7159
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	10/19/2023

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Directions to “ EDMOND AGENDIA NTEZEH ” Practice Location

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