Healthcare Provider Details

I. General information

NPI: 1346150075
Provider Name (Legal Business Name): LOUIS AGBOR MBU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 REGALWOOD TER
BURTONSVILLE MD
20866-2224
US

IV. Provider business mailing address

4467 REGALWOOD TER
BURTONSVILLE MD
20866-2224
US

V. Phone/Fax

Practice location:
  • Phone: 443-832-7812
  • Fax:
Mailing address:
  • Phone: 443-832-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR270992
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: