Healthcare Provider Details

I. General information

NPI: 1578169827
Provider Name (Legal Business Name): RICHARD VOMA JANGMIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1836 METZEROTT RD APT 1103
ADELPHI MD
20783-3448
US

IV. Provider business mailing address

1836 METZEROTT RD APT 1103
ADELPHI MD
20783-3448
US

V. Phone/Fax

Practice location:
  • Phone: 240-429-2980
  • Fax:
Mailing address:
  • Phone: 240-429-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHHA12345
Identifier TypeMEDICAID
Identifier StateDC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: