Provider Demographics
NPI:1902541568
Name:MUDEH, LAWRENCE DONG
Entity Type:Individual
Prefix:
First Name:LAWRENCE DONG
Middle Name:
Last Name:MUDEH
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 1:741 LONGFELLOW ST NW APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3020
Mailing Address - Country:US
Mailing Address - Phone:240-667-6920
Mailing Address - Fax:
Practice Address - Street 1:741 LONGFELLOW ST NW APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3020
Practice Address - Country:US
Practice Address - Phone:240-667-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide