Provider Demographics
NPI:1275856163
Name:BAMBA, N'DAMA M
Entity Type:Individual
Prefix:
First Name:N'DAMA
Middle Name:M
Last Name:BAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406B CRAIN HWY S STE 308
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4094
Mailing Address - Country:US
Mailing Address - Phone:443-952-8255
Mailing Address - Fax:
Practice Address - Street 1:1406B CRAIN HWY S STE 308
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4094
Practice Address - Country:US
Practice Address - Phone:443-952-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0080062208D00000X, 174400000X, 202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner