Healthcare Provider Details

I. General information

NPI: 1700737152
Provider Name (Legal Business Name): BERTILA AKEGEH AZANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 KEVERTON DR
UPPER MARLBORO MD
20774-1837
US

IV. Provider business mailing address

12902 KEVERTON DR
UPPER MARLBORO MD
20774-1837
US

V. Phone/Fax

Practice location:
  • Phone: 240-484-2218
  • Fax:
Mailing address:
  • Phone: 240-484-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: