Healthcare Provider Details

I. General information

NPI: 1912818568
Provider Name (Legal Business Name): ISHMAEL KARGBO ABASS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 58TH AVE
BLADENSBURG MD
20710-1922
US

IV. Provider business mailing address

4265 58TH AVE APT 2
BLADENSBURG MD
20710-1922
US

V. Phone/Fax

Practice location:
  • Phone: 202-718-8791
  • Fax:
Mailing address:
  • Phone: 202-718-8791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006781
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: