Provider Demographics
NPI:1720841125
Name:MBU, STEPHEN EGBE
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EGBE
Last Name:MBU
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 1:5406 MACBETH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1010
Mailing Address - Country:US
Mailing Address - Phone:202-766-7188
Mailing Address - Fax:
Practice Address - Street 1:5406 MACBETH ST APT 2
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1010
Practice Address - Country:US
Practice Address - Phone:202-766-7188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator