Provider Demographics
NPI:1316765712
Name:ROLAND AMBE CHE MBAH, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:ROLAND AMBE CHE MBAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 CHERRYWOOD TER APT 203
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4266
Mailing Address - Country:US
Mailing Address - Phone:240-486-4402
Mailing Address - Fax:
Practice Address - Street 1:5909 CHERRYWOOD TER APT 203
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4266
Practice Address - Country:US
Practice Address - Phone:240-486-4402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC200004239374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide