Provider Demographics
NPI:1336697275
Name:FORSAH, MISPAH
Entity type:Individual
Prefix:
First Name:MISPAH
Middle Name:
Last Name:FORSAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 FAIRVIEW AVE
Mailing Address - Street 2:510
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5978
Mailing Address - Country:US
Mailing Address - Phone:301-408-8537
Mailing Address - Fax:
Practice Address - Street 1:780 FAIRVIEW AVE
Practice Address - Street 2:510
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5978
Practice Address - Country:US
Practice Address - Phone:301-408-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide