Provider Demographics
NPI:1194082545
Name:DEGOH, NELSON Y
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:Y
Last Name:DEGOH
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 1:2000 ERIE ST
Mailing Address - Street 2:APT 202
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2335
Mailing Address - Country:US
Mailing Address - Phone:301-263-5430
Mailing Address - Fax:
Practice Address - Street 1:2000 ERIE ST
Practice Address - Street 2:APT 202
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-2335
Practice Address - Country:US
Practice Address - Phone:301-263-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide