Provider Demographics
NPI:1417715442
Name:BAH, FATMATA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:
Last Name:BAH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:FATMATA
Other - Middle Name:
Other - Last Name:BAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:8113 BAYOU BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1958
Mailing Address - Country:US
Mailing Address - Phone:240-593-4861
Mailing Address - Fax:
Practice Address - Street 1:8113 BAYOU BEND BLVD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-1958
Practice Address - Country:US
Practice Address - Phone:240-593-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR159377363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health