Provider Demographics
NPI:1407541857
Name:BIMOH, BRYANT NGADI
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:NGADI
Last Name:BIMOH
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 1:7777 RIVERDALE RD APT 302
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3937
Mailing Address - Country:US
Mailing Address - Phone:323-994-7367
Mailing Address - Fax:
Practice Address - Street 1:7777 RIVERDALE RD APT 302
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3937
Practice Address - Country:US
Practice Address - Phone:323-994-7367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health