Provider Demographics
NPI:1538748264
Name:TOMEDI, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:TOMEDI
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 1:14163 CASTLE BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4785
Mailing Address - Country:US
Mailing Address - Phone:240-802-9910
Mailing Address - Fax:
Practice Address - Street 1:14163 CASTLE BLVD APT 203
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4785
Practice Address - Country:US
Practice Address - Phone:240-802-9910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA00188418Medicaid