Provider Demographics
NPI:1487073698
Name:KEPONDJO, HERVE RODRIGUE
Entity type:Individual
Prefix:
First Name:HERVE
Middle Name:RODRIGUE
Last Name:KEPONDJO
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 1:1836 METZEROTT RD
Mailing Address - Street 2:APT #920
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783
Mailing Address - Country:US
Mailing Address - Phone:202-465-2397
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD
Practice Address - Street 2:APT #920
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783
Practice Address - Country:US
Practice Address - Phone:202-465-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide