Provider Demographics
NPI:1043570633
Name:MBAH, CLAUDINE AGWI
Entity Type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:AGWI
Last Name:MBAH
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 1:11443 CHERRY HILL RD
Mailing Address - Street 2:APT 301
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3643
Mailing Address - Country:US
Mailing Address - Phone:240-388-8658
Mailing Address - Fax:
Practice Address - Street 1:11443 CHERRY HILL RD
Practice Address - Street 2:APT 301
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3643
Practice Address - Country:US
Practice Address - Phone:240-388-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM100119034098374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide