MEDICARE: ELVIS K NJIMBUBEH

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	:	1780392894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIS K NJIMBUBEH

Provider Business Mailing Address
First Line	:	9615 DONNAN CASTLE CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20723-5975
Country	:	US
Telephone Number	:	202-569-1870
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 MLK JR
Second Line	:
City	:	SOUTH EAST
State	:	DC
Zip	:	20020-2002
Country	:	US
Telephone Number	:	202-800-4387
Fax Number	:

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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