Provider Demographics
NPI:1922864289
Name:AMABO, EDWIN AMBE
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:AMBE
Last Name:AMABO
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 1:10712 MARIETTA ST
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9405
Mailing Address - Country:US
Mailing Address - Phone:301-701-0222
Mailing Address - Fax:
Practice Address - Street 1:10712 MARIETTA ST
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9405
Practice Address - Country:US
Practice Address - Phone:301-701-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator