Healthcare Provider Details

I. General information

NPI: 1891247409
Provider Name (Legal Business Name): GEORGE NJOROGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2016
Last Update Date: 10/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 BENSON AVE
HALETHORPE MD
21227-1035
US

IV. Provider business mailing address

11 RUNNING CT
ESSEX MD
21221-2933
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-7100
  • Fax:
Mailing address:
  • Phone: 443-703-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4507
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: