Healthcare Provider Details

I. General information

NPI: 1861943904
Provider Name (Legal Business Name): EMMANUEL NSOH MBAH I HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 METZEROTT RD APT 402
ADELPHI MD
20783
US

IV. Provider business mailing address

1830 METZEROTT RD APT 402
ADELPHI MD
20783-3485
US

V. Phone/Fax

Practice location:
  • Phone: 301-300-4106
  • Fax:
Mailing address:
  • Phone: 301-300-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA12449
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: