Provider Demographics
NPI:1497189591
Name:EBAH EDONGOLE, EMADE
Entity type:Individual
Prefix:
First Name:EMADE
Middle Name:
Last Name:EBAH EDONGOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SONOMA LN
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2689
Mailing Address - Country:US
Mailing Address - Phone:240-667-6202
Mailing Address - Fax:
Practice Address - Street 1:1311 SONOMA LN
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2689
Practice Address - Country:US
Practice Address - Phone:240-667-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCRN500327792163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide