Healthcare Provider Details

I. General information

NPI: 1043708829
Provider Name (Legal Business Name): MR. MATHIAS MBAH NDAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 DR BEANS LEGACY CIR
BOWIE MD
20720-6385
US

IV. Provider business mailing address

2811 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-3865
US

V. Phone/Fax

Practice location:
  • Phone: 301-851-9596
  • Fax:
Mailing address:
  • Phone: 202-894-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13611
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: