MEDICARE: RANDY CHE NDISANG

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	:	1275332538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY CHE NDISANG

Provider Business Mailing Address
First Line	:	13505 OAKLANDS MANOR DR
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1426
Country	:	US
Telephone Number	:	240-991-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	13505 OAKLANDS MANOR DR
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-1426
Country	:	US
Telephone Number	:	240-991-8818
Fax Number	:

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

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	03/10/2025

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Directions to “ RANDY CHE NDISANG ” Practice Location

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