Provider Demographics
NPI:1265224711
Name:BAMBA, ADAM OTHMAN DJELLE
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:OTHMAN DJELLE
Last Name:BAMBA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PARRS RIDGE DR # 1025
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20868-9743
Mailing Address - Country:US
Mailing Address - Phone:227-251-2885
Mailing Address - Fax:
Practice Address - Street 1:816 THAYER AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4508
Practice Address - Country:US
Practice Address - Phone:301-755-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician