Provider Demographics
NPI:1033997390
Name:AGBORTARH, MBI TARH
Entity Type:Individual
Prefix:
First Name:MBI
Middle Name:TARH
Last Name:AGBORTARH
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 1:7903 ORION CIR UNIT 326A
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-3110
Mailing Address - Country:US
Mailing Address - Phone:832-348-6479
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 110
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1849
Practice Address - Country:US
Practice Address - Phone:202-489-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator