Healthcare Provider Details

I. General information

NPI: 1982509097
Provider Name (Legal Business Name): PRECIOUS M MBAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7749 RIVERDALE RD APT 103
NEW CARROLLTON MD
20784-3918
US

IV. Provider business mailing address

7749 RIVERDALE RD APT 103
NEW CARROLLTON MD
20784-3918
US

V. Phone/Fax

Practice location:
  • Phone: 240-678-6797
  • Fax:
Mailing address:
  • Phone: 240-678-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: