Provider Demographics
NPI:1114687647
Name:MBAH, ROBERT TEWAN
Entity Type:Individual
Prefix:
First Name:ROBERT TEWAN
Middle Name:
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 1:7829 EMILYS WAY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2464
Mailing Address - Country:US
Mailing Address - Phone:202-560-3759
Mailing Address - Fax:
Practice Address - Street 1:7829 EMILYS WAY
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2464
Practice Address - Country:US
Practice Address - Phone:202-560-3759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide