Healthcare Provider Details

I. General information

NPI: 1619744315
Provider Name (Legal Business Name): BOLA G AHMED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 HUNT PL NE
WASHINGTON DC
20019-3565
US

IV. Provider business mailing address

3620 JEFF RD
GLENARDEN MD
20774-2609
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-4300
  • Fax: 202-388-4339
Mailing address:
  • Phone: 301-454-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500015321
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: