Provider Demographics
NPI:1932502010
Name:EBAH, STANLEY ENONGENE
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ENONGENE
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
Mailing Address - Street 2:APT B6
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1854
Mailing Address - Country:US
Mailing Address - Phone:240-467-7761
Mailing Address - Fax:
Practice Address - Street 1:5016 TOWNSEND WAY
Practice Address - Street 2:APT B6
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1888
Practice Address - Country:US
Practice Address - Phone:240-467-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide