MEDICARE: SERGES ADOLPHE NSECKE

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
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1639856941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGES ADOLPHE NSECKE

Provider Business Mailing Address
First Line	:	6315 WOOD POINTE DR
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-2107
Country	:	US
Telephone Number	:	202-830-8642
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 WOOD POINTE DR
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-2107
Country	:	US
Telephone Number	:	202-830-8642
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	07/31/2023

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