Provider Demographics
NPI:1053026682
Name:MBAKU, RICHARD ABANG
Entity type:Individual
Prefix:
First Name:RICHARD ABANG
Middle Name:
Last Name:MBAKU
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 1:3801 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2122
Mailing Address - Country:US
Mailing Address - Phone:202-439-3002
Mailing Address - Fax:
Practice Address - Street 1:3801 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2122
Practice Address - Country:US
Practice Address - Phone:202-439-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide