Provider Demographics
NPI:1104284660
Name:MBAH, ROBINSON T
Entity type:Individual
Prefix:
First Name:ROBINSON
Middle Name:T
Last Name:MBAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 WOODBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3600
Mailing Address - Country:US
Mailing Address - Phone:240-467-7786
Mailing Address - Fax:
Practice Address - Street 1:9813 WOODBERRY ST
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3600
Practice Address - Country:US
Practice Address - Phone:240-467-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide