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General NPI Number Information
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NPI Number | 1700364445
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Entity Type | Individual
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Provider Name | MRS. TOM BASSEY EDUNG
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Gender | Male
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 617 STEMMERS RUN RD STE I
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City | BALTIMORE
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State | MD
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Zip | 21221-3361
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Country | US
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Telephone | 443-453-2069
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Fax | 443-559-5645
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Provider Business Mailing Address
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Address Line | 617 STEMMERS RUN RD STE I
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City | BALTIMORE
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State | MD
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Zip | 21221-3361
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Country | US
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Telephone | 443-453-2069
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Fax | 443-559-5645
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R4294
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License Number State | MD
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