Provider Demographics
NPI:1154994143
Name:TCHOUMTE, ODILIA
Entity type:Individual
Prefix:
First Name:ODILIA
Middle Name:
Last Name:TCHOUMTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 CASTLE BLVD APT 402
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4738
Mailing Address - Country:US
Mailing Address - Phone:240-310-4963
Mailing Address - Fax:
Practice Address - Street 1:3305 THEODORE R HAGANS DR NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4321
Practice Address - Country:US
Practice Address - Phone:202-867-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant