Provider Demographics
NPI:1962762286
Name:MUJEM, ALFRED
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:MUJEM
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 1:9063 CONGRESS PL
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4729
Mailing Address - Country:US
Mailing Address - Phone:708-513-7708
Mailing Address - Fax:
Practice Address - Street 1:9063 CONGRESS PL
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4729
Practice Address - Country:US
Practice Address - Phone:708-513-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA1728374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty