Healthcare Provider Details

I. General information

NPI: 1710739065
Provider Name (Legal Business Name): BRIGHT OWOAHENE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 07/22/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 SAMUEL MORSE DR STE 100
COLUMBIA MD
21046-3444
US

IV. Provider business mailing address

7020 SAMUEL MORSE DR STE 100 7020 SAMUEL MORSE DR STE 100
COLUMBIA MD
21046-3444
US

V. Phone/Fax

Practice location:
  • Phone: 301-444-5001
  • Fax:
Mailing address:
  • Phone: 240-595-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: