Healthcare Provider Details

I. General information

NPI: 1982157533
Provider Name (Legal Business Name): ELVIS NDEMAZEAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 WHITFIELD CHAPEL RD APT 101
LANHAM MD
20706-2548
US

IV. Provider business mailing address

4004 ROMSEY DR
BOWIE MD
20721-2810
US

V. Phone/Fax

Practice location:
  • Phone: 240-667-6004
  • Fax:
Mailing address:
  • Phone: 240-667-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29632
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12304
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: