Provider Demographics
NPI:1215799648
Name:RIKAM MOUDJI, NADINE
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:
Last Name:RIKAM MOUDJI
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 1:5908 KING ARTHUR WAY
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8908
Mailing Address - Country:US
Mailing Address - Phone:240-533-1835
Mailing Address - Fax:
Practice Address - Street 1:5908 KING ARTHUR WAY
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-8908
Practice Address - Country:US
Practice Address - Phone:240-533-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator