Provider Demographics
NPI:1306342043
Name:CONSTANTINE, IMENE
Entity type:Individual
Prefix:
First Name:IMENE
Middle Name:
Last Name:CONSTANTINE
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 1:2604 RITTENHOUSE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3314
Mailing Address - Country:US
Mailing Address - Phone:240-501-7540
Mailing Address - Fax:
Practice Address - Street 1:2604 RITTENHOUSE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3314
Practice Address - Country:US
Practice Address - Phone:240-501-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13544374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide