Provider Demographics
NPI:1447502760
Name:EDILI, EMMANUEL O
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:O
Last Name:EDILI
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 1:11260 KETTERING PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1566
Mailing Address - Country:US
Mailing Address - Phone:202-291-7226
Mailing Address - Fax:202-291-4009
Practice Address - Street 1:439 0NEIDA PLACE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-291-7226
Practice Address - Fax:202-291-4009
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036061400Medicaid