Provider Demographics
NPI:1427317080
Name:NZEFEH, MARTIN NKEMAMIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:NKEMAMIN
Last Name:NZEFEH
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 1:9814 PHEASANT RUN CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3192
Mailing Address - Country:US
Mailing Address - Phone:240-855-6293
Mailing Address - Fax:410-766-0240
Practice Address - Street 1:1406 CRAIN HWY S # 104-106
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4058
Practice Address - Country:US
Practice Address - Phone:410-766-6624
Practice Address - Fax:410-766-0240
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
MDR213812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No374U00000XNursing Service Related ProvidersHome Health Aide