Individual
BLECK CHE ROY WANDJI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10807 POOKEY WAY, UPPER MARLBORO, MD 20774-6041
(240) 872-8873
Mailing address
10807 POOKEY WAY, UPPER MARLBORO, MD 20774-6041
(240) 872-8873
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
DC
Other
Enumeration date
07/10/2023
Last updated
07/25/2023
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