MEDICARE: MBAH JOSEPHINE ENDAM

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	251S00000X	Community/Behavioral Health Agency		DC
2	164W00000X	Licensed Practical Nurse	LPN1008771	DC
3	374U00000X	Home Health Aide		DC

General Provider Information

NPI Number	:	1548521388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MBAH JOSEPHINE ENDAM

Provider Business Mailing Address
First Line	:	10005 E FRANKLIN AVE
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9279
Country	:	US
Telephone Number	:	240-551-4427
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 MARTIN LUTHER KING JR AVE SW STE A2
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4933
Country	:	US
Telephone Number	:	202-318-0179
Fax Number	:

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

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	03/13/2026

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