Provider Demographics
NPI:1194578070
Name:NKEMTAJI, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:NKEMTAJI
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 1:6321 LANDOVER RD APT 104
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1322
Mailing Address - Country:US
Mailing Address - Phone:240-467-4925
Mailing Address - Fax:
Practice Address - Street 1:6321 LANDOVER RD APT 104
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1322
Practice Address - Country:US
Practice Address - Phone:240-467-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator