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NPI Code Detail

MEDICARE: PENN ANONCHU FIDELIS

MEDICARE: PENN ANONCHU FIDELIS
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
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1306625678
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENN ANONCHU FIDELIS
Provider Business Mailing Address
First Line : 3208 TOLEDO PL
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-4120
Country : US
Telephone Number : 240-926-7404
Fax Number :
Provider Business Practice Location Address
First Line : 3208 TOLEDO PL
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-4120
Country : US
Telephone Number : 240-926-7404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2023
Last Update Date : 09/26/2023

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Directions to “ PENN ANONCHU FIDELIS ” Practice Location

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