Provider Demographics
NPI:1669282422
Name:BAH, IBRAHIM
Entity type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:
Last Name:BAH
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 1:13820 CASTLE BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7346
Mailing Address - Country:US
Mailing Address - Phone:240-501-5454
Mailing Address - Fax:
Practice Address - Street 1:13820 CASTLE BLVD APT 203
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7346
Practice Address - Country:US
Practice Address - Phone:240-501-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator