Healthcare Provider Details

I. General information

NPI: 1427317080
Provider Name (Legal Business Name): MARTIN NKEMAMIN NZEFEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 CRAIN HWY S # 104-106
GLEN BURNIE MD
21061-4058
US

IV. Provider business mailing address

9814 PHEASANT RUN CT
LAUREL MD
20708-3192
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-6624
  • Fax: 410-766-0240
Mailing address:
  • Phone: 240-855-6293
  • Fax: 410-766-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR213812
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: