Provider Demographics
NPI:1588925549
Name:MBAH, AJEIDEH LOVELINE
Entity type:Individual
Prefix:
First Name:AJEIDEH
Middle Name:LOVELINE
Last Name:MBAH
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 1:18558 EAGLES ROOST DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2102
Mailing Address - Country:US
Mailing Address - Phone:240-388-5909
Mailing Address - Fax:
Practice Address - Street 1:18558 EAGLES ROOST DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2102
Practice Address - Country:US
Practice Address - Phone:240-388-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide