Healthcare Provider Details

I. General information

NPI: 1932062486
Provider Name (Legal Business Name): EZEKIEL TACHAM AZEMAGAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 58TH AVE APT 10
BLADENSBURG MD
20710-1934
US

IV. Provider business mailing address

4241 58TH AVE APT 10
BLADENSBURG MD
20710-1934
US

V. Phone/Fax

Practice location:
  • Phone: 240-467-0319
  • Fax:
Mailing address:
  • Phone: 240-467-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHHA200005704
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: