Provider Demographics
NPI:1063225860
Name:AWANCHIRI, GODLOVE SUH
Entity type:Individual
Prefix:
First Name:GODLOVE
Middle Name:SUH
Last Name:AWANCHIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12829 CAROUSEL CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6415
Mailing Address - Country:US
Mailing Address - Phone:301-393-7427
Mailing Address - Fax:
Practice Address - Street 1:12829 CAROUSEL CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6415
Practice Address - Country:US
Practice Address - Phone:301-393-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty