Healthcare Provider Details

I. General information

NPI: 1992363600
Provider Name (Legal Business Name): LIONEL CHAH MBAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8709 63RD AVE
BERWYN HEIGHTS MD
20740-2763
US

IV. Provider business mailing address

8709 63RD AVE
BERWYN HEIGHTS MD
20740-2763
US

V. Phone/Fax

Practice location:
  • Phone: 240-467-7466
  • Fax:
Mailing address:
  • Phone: 240-467-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14417
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: