Basic Information
| Provider Information | |||||||||
| NPI: | 1477805422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLEGIS HEALTHCARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 GREENBELT ROAD | ||||||||
| Address2: | SUITE M-18 | ||||||||
| City: | BERWYN HEIGHTS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207404250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012724267 | ||||||||
| FaxNumber: | 3015605557 | ||||||||
| Practice Location | |||||||||
| Address1: | 6201 GREENBELT RD STE M18 | ||||||||
| Address2: | |||||||||
| City: | BERWYN HEIGHTS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207402333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012724267 | ||||||||
| FaxNumber: | 3015605557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RADJI | ||||||||
| AuthorizedOfficialFirstName: | KOUDIRATOU | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3012724267 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R156395 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 334439800 | 05 | MD | MEDICAID |