Provider Demographics
NPI:1710523022
Name:MBANGOWAH, ABRAHAM APENE (NP)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:APENE
Last Name:MBANGOWAH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 PEARTREE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3007
Mailing Address - Country:US
Mailing Address - Phone:240-481-6178
Mailing Address - Fax:
Practice Address - Street 1:1111 SPRING ST STE 220
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:240-641-8160
Practice Address - Fax:240-641-8166
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR202296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily