Provider Demographics
NPI:1548096464
Name:BAMIGBEGBIN, SAMSON
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:
Last Name:BAMIGBEGBIN
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 1:710 ELFIN AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2831
Mailing Address - Country:US
Mailing Address - Phone:202-749-1343
Mailing Address - Fax:
Practice Address - Street 1:710 ELFIN AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-2831
Practice Address - Country:US
Practice Address - Phone:202-749-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide