Healthcare Provider Details

I. General information

NPI: 1730511981
Provider Name (Legal Business Name): ESABELLA MAH TEBID MBAH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2013
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 GREENBELT RD STE 104
LANHAM MD
20706-6204
US

IV. Provider business mailing address

4512 DOCTOR BEANS LEGACY CIR
BOWIE MD
20720-6384
US

V. Phone/Fax

Practice location:
  • Phone: 202-257-2130
  • Fax:
Mailing address:
  • Phone: 202-257-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1009165
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR174293
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: