Provider Demographics
NPI:1275877631
Name:SAM, BAABA
Entity Type:Individual
Prefix:MISS
First Name:BAABA
Middle Name:
Last Name:SAM
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 1:13662 OFFICE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4217
Mailing Address - Country:US
Mailing Address - Phone:703-910-7257
Mailing Address - Fax:703-910-7093
Practice Address - Street 1:13662 OFFICE PL STE 104
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4217
Practice Address - Country:US
Practice Address - Phone:703-910-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-23
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide