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General NPI Number Information
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NPI Number | 1063113397
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Entity Type | Organization
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Legal Business Name | DR. BAMBA'S HEALTH AND MEDICAL CENTER
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 03/21/2023
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Provider Practice Location Address
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Address Line | 1406B CRAIN HWY S STE 308
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4094
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Country | US
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Telephone | 443-953-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 1406B CRAIN HWY S STE 308
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4094
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Country | US
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Telephone | 443-953-8255
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | N'DAMA BAMBA
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Credential | MD
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Telephone | 443-953-8255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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