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General NPI Number Information
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NPI Number | 1811794712
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Entity Type | Individual
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Provider Name | BETRAND ABAH ICHU
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Gender | Male
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 702 15TH ST NE
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City | WASHINGTON
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State | DC
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Zip | 20002-4508
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Country | US
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Telephone | 202-388-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 184 JOYCETON TER UPPR MALBORO
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-1480
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Country | US
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Telephone | 240-927-8564
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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