MEDICARE: THERESA BAWUAH

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1588925127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA BAWUAH

Provider Business Mailing Address
First Line	:	8509 MONTPELIER DR
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-2307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 MARION BARRY AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5615
Country	:	US
Telephone Number	:	202-890-9972
Fax Number	:

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

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	01/31/2025

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Directions to “ THERESA BAWUAH ” Practice Location

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