Provider Demographics
NPI:1962844209
Name:HEALTHCAREBAHN
Entity Type:Organization
Organization Name:HEALTHCAREBAHN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:TITA
Authorized Official - Last Name:ASANGONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-847-6810
Mailing Address - Street 1:11106 SNOWDEN POND RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3055
Mailing Address - Country:US
Mailing Address - Phone:443-847-6810
Mailing Address - Fax:
Practice Address - Street 1:11106 SNOWDEN POND RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3055
Practice Address - Country:US
Practice Address - Phone:443-847-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5000000000039429332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies