Provider Demographics
NPI:1396424701
Name:ABONGBI, INDIRA FRI
Entity type:Individual
Prefix:
First Name:INDIRA FRI
Middle Name:
Last Name:ABONGBI
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 1:16 BANNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1438
Mailing Address - Country:US
Mailing Address - Phone:240-548-8081
Mailing Address - Fax:
Practice Address - Street 1:16 BANNINGTON DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1438
Practice Address - Country:US
Practice Address - Phone:240-548-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide