Provider Demographics
NPI:1457716847
Name:BAH, FATMATA
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:
Last Name:BAH
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 1:1414 CANADIEN GEESE CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7062
Mailing Address - Country:US
Mailing Address - Phone:202-437-0148
Mailing Address - Fax:
Practice Address - Street 1:100 M ST SE
Practice Address - Street 2:SUITE # 601
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3519
Practice Address - Country:US
Practice Address - Phone:202-437-0148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194797363LP0808X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator