Provider Demographics
NPI:1699911966
Name:RADJI, KOUDIRATOU (NP)
Entity type:Individual
Prefix:MISS
First Name:KOUDIRATOU
Middle Name:
Last Name:RADJI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT RD STE M18
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2333
Mailing Address - Country:US
Mailing Address - Phone:301-272-4267
Mailing Address - Fax:301-560-5557
Practice Address - Street 1:6201 GREENBELT RD STE M18
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2333
Practice Address - Country:US
Practice Address - Phone:301-272-4267
Practice Address - Fax:301-560-5557
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR156395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily