Provider Demographics
NPI:1740801901
Name:MAHBOSUNG, VERA
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:MAHBOSUNG
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 1:6933 LAMONT DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4606
Mailing Address - Country:US
Mailing Address - Phone:240-784-0013
Mailing Address - Fax:
Practice Address - Street 1:6933 LAMONT DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4606
Practice Address - Country:US
Practice Address - Phone:240-784-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15199374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide