Provider Demographics
NPI:1164784641
Name:BAH-SOW, MARIAMA JELOH (MD)
Entity Type:Individual
Prefix:
First Name:MARIAMA
Middle Name:JELOH
Last Name:BAH-SOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIAMA
Other - Middle Name:JELOH
Other - Last Name:BAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:410-735-4244
Practice Address - Street 1:17001 SCIENCE DR STE 102
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:240-556-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine