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General NPI Number Information
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NPI Number | 1063225142
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Entity Type | Individual
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Provider Name | BASIL TEGHEN NDUM RN
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Gender | Male
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 9105 JOUSTING LN
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-4388
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Country | US
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Telephone | 240-872-6598
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 RICHMOND HWY
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City | ALEXANDRIA
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State | VA
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Zip | 22305-3044
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Country | US
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Telephone | 240-872-6598
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 0001301762
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License Number State | VA
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