MEDICARE: AUSTIN IBE

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	374U00000X	Home Health Aide	HHA12630	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I100074038643	OTHER	MD	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1467978387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN IBE

Provider Business Mailing Address
First Line	:	15604 HAYNES RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3302
Country	:	US
Telephone Number	:	240-544-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	14625 BALTIMORE AVE
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-4902
Country	:	US
Telephone Number	:	240-544-8992
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	08/22/2017

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Directions to “ AUSTIN IBE ” Practice Location

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