MEDICARE: MR. COLINS DJIMELI MENSAH

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	163WH0200X	Home Health Registered Nurse	2538775345	MD

General Provider Information

NPI Number	:	1821438086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLINS DJIMELI MENSAH

Provider Business Mailing Address
First Line	:	9513 MUIRKIRK RD
Second Line	:	APT T1
City	:	LAUREL
State	:	MD
Zip	:	20708-2765
Country	:	US
Telephone Number	:	334-492-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	9513 MUIRKIRK RD
Second Line	:	APT T1
City	:	LAUREL
State	:	MD
Zip	:	20708-2765
Country	:	US
Telephone Number	:	334-492-1240
Fax Number	:

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

Provider Enumeration Date	:	07/02/2013
Last Update Date	:	07/02/2013

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