Provider Demographics
NPI:1861943904
Name:MBAH, EMMANUEL NSOH I (HHA)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:NSOH
Last Name:MBAH
Suffix:I
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 METZEROTT RD APT 402
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3485
Mailing Address - Country:US
Mailing Address - Phone:301-300-4106
Mailing Address - Fax:
Practice Address - Street 1:1830 METZEROTT RD APT 402
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783
Practice Address - Country:US
Practice Address - Phone:301-300-4106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12449251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health