Healthcare Provider Details

I. General information

NPI: 1679154694
Provider Name (Legal Business Name): PAULINE JO RAGO ADIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SANDY SPRING RD STE 250
LAUREL MD
20707-3527
US

IV. Provider business mailing address

8101 SANDY SPRING RD STE 250
LAUREL MD
20707-3527
US

V. Phone/Fax

Practice location:
  • Phone: 800-994-5403
  • Fax:
Mailing address:
  • Phone: 800-994-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26745
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: