Provider Demographics
NPI:1205651890
Name:MBUNWE ROLAND, ADAMU
Entity type:Individual
Prefix:
First Name:ADAMU
Middle Name:
Last Name:MBUNWE ROLAND
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 1:6319 LANDOVER RD APT 204
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1320
Mailing Address - Country:US
Mailing Address - Phone:240-467-7377
Mailing Address - Fax:
Practice Address - Street 1:6319 LANDOVER RD APT 204
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1320
Practice Address - Country:US
Practice Address - Phone:240-467-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator