MEDICARE: DR. DIEUDONNE CHE NDIFOR

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	225100000X	Physical Therapist	PT872403	DC
2	225100000X	Physical Therapist	27258	MD

General Provider Information

NPI Number	:	1740752815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEUDONNE CHE NDIFOR

Provider Business Mailing Address
First Line	:	8500 NEW HAMPSHIRE AVE APT 129
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-3317
Country	:	US
Telephone Number	:	202-602-9799
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 NEW HAMPSHIRE AVE APT 129
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-3317
Country	:	US
Telephone Number	:	202-602-9799
Fax Number	:

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

Provider Enumeration Date	:	12/29/2018
Last Update Date	:	03/02/2019

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