Provider Demographics
NPI:1528619475
Name:ANGUM, ODILIA T
Entity type:Individual
Prefix:
First Name:ODILIA
Middle Name:T
Last Name:ANGUM
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 1:3317 CHAUNCEY PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1020
Mailing Address - Country:US
Mailing Address - Phone:301-806-4962
Mailing Address - Fax:
Practice Address - Street 1:3317 CHAUNCEY PL
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1020
Practice Address - Country:US
Practice Address - Phone:301-806-4962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide