MEDICARE: JOHN NITCHEW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1245097666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN NITCHEW

Provider Business Mailing Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6935 RIVERDALE RD
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-1125
Country	:	US
Telephone Number	:	240-475-4487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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Directions to “ JOHN NITCHEW ” Practice Location

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