Provider Demographics
NPI:1548951817
Name:AZONG, ADELINE L
Entity type:Individual
Prefix:MS
First Name:ADELINE
Middle Name:L
Last Name:AZONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADELINE
Other - Middle Name:L
Other - Last Name:AZONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1603 SUN HIGH TER
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1622
Mailing Address - Country:US
Mailing Address - Phone:240-603-3340
Mailing Address - Fax:
Practice Address - Street 1:1603 SUN HIGH TER
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1622
Practice Address - Country:US
Practice Address - Phone:240-603-3340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR229040363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health