Provider Demographics
NPI:1174984975
Name:BAH, MAMADOU T (MBA)
Entity type:Individual
Prefix:
First Name:MAMADOU
Middle Name:T
Last Name:BAH
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S HAMILTON RD STE L
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2426
Mailing Address - Country:US
Mailing Address - Phone:614-556-0342
Mailing Address - Fax:
Practice Address - Street 1:1510 S HAMILTON RD STE L
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2426
Practice Address - Country:US
Practice Address - Phone:614-556-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health