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Individual provider Active NPI Community Health Worker · Greenbelt, MD

NPI 1649189648 · NPPES record last updated Sep 4, 2026

Key facts

NPI
1649189648
Entity type
Individual (NPI type 1)
Primary specialty
Community Health Worker 172V00000X
Practice address
5917 Cherrywood Ter Apt 105
Greenbelt, MD 20770-4271
Phone
(202) 940-1396
NPI assigned
Sep 4, 2026
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X MD Yes

Addresses

Primary practice location

5917 Cherrywood Ter Apt 105
Greenbelt, MD 20770-4271

Mailing address

5917 Cherrywood Ter Apt 105
Greenbelt, MD 20770-4271
Phone (202) 940-1396

Other providers in Greenbelt, MD

All providers in Greenbelt, MD · Community Health Worker in Maryland

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2026. Information in NPPES is self-reported and not verified by CMS.
  • NUCC Health Care Provider Taxonomy: specialty names.

Verify at the official NPI Registry.