MEDICARE: MAMADOU T BAH MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174984975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMADOU T BAH MBA

Provider Business Mailing Address
First Line	:	1510 S HAMILTON RD STE L
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2426
Country	:	US
Telephone Number	:	614-556-0342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 S HAMILTON RD STE L
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2426
Country	:	US
Telephone Number	:	614-556-0342
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2016
Last Update Date	:	04/16/2021

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