Provider Demographics
NPI:1407534100
Name:MAMMAH, EDORA N
Entity Type:Individual
Prefix:
First Name:EDORA
Middle Name:N
Last Name:MAMMAH
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 1:8902 91ST PL
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1914
Mailing Address - Country:US
Mailing Address - Phone:301-768-0054
Mailing Address - Fax:
Practice Address - Street 1:8902 91ST PL
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1914
Practice Address - Country:US
Practice Address - Phone:301-768-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator