Provider Demographics
NPI:1548011133
Name:CONTE, MAMADOUBA
Entity type:Individual
Prefix:
First Name:MAMADOUBA
Middle Name:
Last Name:CONTE
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 1:1801 CENTURY CITY E # PAT4
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4428
Mailing Address - Country:US
Mailing Address - Phone:646-249-1936
Mailing Address - Fax:
Practice Address - Street 1:1801 CENTURY CITY E APT 4
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2776
Practice Address - Country:US
Practice Address - Phone:646-249-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty