Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Derick T Mukom

Individual provider Case Manager/Care Coordinator · NPI 1013892074

Derick T Mukom is a Case Manager/Care Coordinator in Glenn Dale, Maryland. Practices as a sole proprietor. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
2

Practice location Address checks out

6911 Fountain Park Dr
Glenn Dale, MD 20769-9484
Phone: (832) 988-8970
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Case Manager/Care Coordinator (primary) Taxonomy 171M00000X
Community Health Worker Taxonomy 172V00000X

Record details

NPI number1013892074
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 8, 2025
Last updated in NPPESOctober 23, 2025
Certification dateOctober 23, 2025
Mailing address6911 Fountain Park Dr, Glenn Dale, MD 20769-9484

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