Provider Demographics
NPI:1689933848
Name:EBAH, MANFRED AKWENLE
Entity Type:Individual
Prefix:
First Name:MANFRED
Middle Name:AKWENLE
Last Name:EBAH
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 1:5016 TOWNSEND WAY APT B6
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1888
Mailing Address - Country:US
Mailing Address - Phone:301-377-6535
Mailing Address - Fax:
Practice Address - Street 1:5016 TOWNSEND WAY APT B6
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1888
Practice Address - Country:US
Practice Address - Phone:301-377-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE100581027888374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide