Provider Demographics
NPI:1053029991
Name:MBANWI, LLOYD T
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:T
Last Name:MBANWI
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 1:6733 NEW HAMPSHIRE AVE APT 1007
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-2858
Mailing Address - Country:US
Mailing Address - Phone:240-886-9515
Mailing Address - Fax:
Practice Address - Street 1:6733 NEW HAMPSHIRE AVE APT 1007
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-2858
Practice Address - Country:US
Practice Address - Phone:240-886-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator