Healthcare Provider Details

I. General information

NPI: 1083581730
Provider Name (Legal Business Name): KEITH NTSEH NDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 FIELDSTONE WAY
HYATTSVILLE MD
20785-4778
US

IV. Provider business mailing address

8432 FIELDSTONE WAY
HYATTSVILLE MD
20785-4778
US

V. Phone/Fax

Practice location:
  • Phone: 240-424-1822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: