NPI 1013892074

Derick T Mukom

Practitioner Case Manager/Care Coordinator Glenn Dale, MD

Practice location

Address: 6911 Fountain Park Dr, Glenn Dale, MD 20769-9484
Phone: (832) 988-8970

Registered specialties (2)

Case Manager/Care Coordinator Primary

Other Service Providers Taxonomy 171M00000X

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Community Health Worker

Other Service Providers Taxonomy 172V00000X

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Registry record

NPI: 1013892074
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 Aug 2025
Record last updated: 23 Oct 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.