Provider Demographics
NPI:1477311744
Name:BAH, STEPHANIE ABONG
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ABONG
Last Name:BAH
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 1:10602 FORESTGATE PL
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2036
Mailing Address - Country:US
Mailing Address - Phone:240-726-0642
Mailing Address - Fax:
Practice Address - Street 1:10602 FORESTGATE PL
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2036
Practice Address - Country:US
Practice Address - Phone:240-726-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide