MEDICARE: BALGUISSA SAWADOGO

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		MD

General Provider Information

NPI Number	:	1760746572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALGUISSA SAWADOGO

Provider Business Mailing Address
First Line	:	8208 ROANOKE AVE
Second Line	:	APT104
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6224
Country	:	US
Telephone Number	:	301-728-4907
Fax Number	:

Provider Business Practice Location Address
First Line	:	8208 ROANOKE AVE
Second Line	:	APT104
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6224
Country	:	US
Telephone Number	:	301-728-4907
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	07/21/2022

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Directions to “ BALGUISSA SAWADOGO ” Practice Location

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