Healthcare Provider Details

I. General information

NPI: 1457716847
Provider Name (Legal Business Name): FATMATA BAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 MAPLE LAWN BLVD STE 302
FULTON MD
20759-2681
US

IV. Provider business mailing address

1414 CANADIEN GEESE CT
UPPER MARLBORO MD
20774-7062
US

V. Phone/Fax

Practice location:
  • Phone: 202-437-0148
  • Fax: 240-371-6222
Mailing address:
  • Phone: 202-437-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR194797
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: