Provider Demographics
NPI:1679030241
Name:TOMGBEHA, MARCELINE ASEHBO
Entity Type:Individual
Prefix:
First Name:MARCELINE
Middle Name:ASEHBO
Last Name:TOMGBEHA
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 1:6216 BREEZEWOOD DR APT 203
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4116
Mailing Address - Country:US
Mailing Address - Phone:240-467-4000
Mailing Address - Fax:
Practice Address - Street 1:9106 SPRINGHILL LN APT 102
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-5270
Practice Address - Country:US
Practice Address - Phone:240-467-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA14340374U00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide