Provider Demographics
NPI:1043827793
Name:MBAH, ELVIS TINONG
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:TINONG
Last Name:MBAH
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 1:3504 HUBBARD RD APT 204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2068
Mailing Address - Country:US
Mailing Address - Phone:540-628-5727
Mailing Address - Fax:
Practice Address - Street 1:3504 HUBBARD RD APT 204
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2068
Practice Address - Country:US
Practice Address - Phone:540-628-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant