Healthcare Provider Details

I. General information

NPI: 1275856163
Provider Name (Legal Business Name): N'DAMA M BAMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 07/28/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406B CRAIN HWY S STE 308
GLEN BURNIE MD
21061-4094
US

IV. Provider business mailing address

1406B CRAIN HWY S STE 308
GLEN BURNIE MD
21061-4094
US

V. Phone/Fax

Practice location:
  • Phone: 443-952-8255
  • Fax:
Mailing address:
  • Phone: 443-952-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0080062
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0080062
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberD0080062
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: