Provider Demographics
NPI:1598598872
Name:MUGROH, BENEVOLENT
Entity type:Individual
Prefix:
First Name:BENEVOLENT
Middle Name:
Last Name:MUGROH
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 1:13006 BOYKIN PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5619
Mailing Address - Country:US
Mailing Address - Phone:202-696-6869
Mailing Address - Fax:
Practice Address - Street 1:13006 BOYKIN PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5619
Practice Address - Country:US
Practice Address - Phone:202-696-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide