MEDICARE: ALEXANDER EIGBEFO

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	374U00000X	Home Health Aide	HHA11965	DC
2	376K00000X	Nurse's Aide	NA00607852	DC
3	376K00000X	Nurse's Aide	A00158178	MD

General Provider Information

NPI Number	:	1710331046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER EIGBEFO

Provider Business Mailing Address
First Line	:	13205 EDDINGTON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1942
Country	:	US
Telephone Number	:	240-701-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	13205 EDDINGTON DR
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1942
Country	:	US
Telephone Number	:	240-701-4566
Fax Number	:

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

Provider Enumeration Date	:	04/23/2016
Last Update Date	:	04/23/2016

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