Healthcare Provider Details

I. General information

NPI: 1366196610
Provider Name (Legal Business Name): MBOH GERALD FORKWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11454 STEWART LN APT C2
SILVER SPRING MD
20904-2231
US

IV. Provider business mailing address

11454 STEWART LN APT C2
SILVER SPRING MD
20904-2231
US

V. Phone/Fax

Practice location:
  • Phone: 651-443-9392
  • Fax:
Mailing address:
  • Phone: 651-443-9392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: