Provider Demographics
NPI:1548623309
Name:AJIDUAH, CHUKS
Entity type:Individual
Prefix:
First Name:CHUKS
Middle Name:
Last Name:AJIDUAH
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 1:10405 FORESTGROVE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2827
Mailing Address - Country:US
Mailing Address - Phone:240-334-8130
Mailing Address - Fax:
Practice Address - Street 1:10405 FORESTGROVE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-2827
Practice Address - Country:US
Practice Address - Phone:240-334-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide