Provider Demographics
NPI:1205603255
Name:EBAI, SAMUEL EGBE
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EGBE
Last Name:EBAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2075
Mailing Address - Country:US
Mailing Address - Phone:240-289-3923
Mailing Address - Fax:
Practice Address - Street 1:5802 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2075
Practice Address - Country:US
Practice Address - Phone:240-289-3923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator