Provider Demographics
NPI:1679383434
Name:MUDOH, HENRY
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:MUDOH
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 1:8004 CRADDOCK RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3049
Mailing Address - Country:US
Mailing Address - Phone:240-643-2141
Mailing Address - Fax:
Practice Address - Street 1:8004 CRADDOCK RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3049
Practice Address - Country:US
Practice Address - Phone:240-643-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide