Provider Demographics
NPI:1881563708
Name:BOMA, BERTRAND
Entity type:Individual
Prefix:
First Name:BERTRAND
Middle Name:
Last Name:BOMA
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 1:2307 WADLOW LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2299
Mailing Address - Country:US
Mailing Address - Phone:301-682-1311
Mailing Address - Fax:301-682-1311
Practice Address - Street 1:2307 WADLOW LN
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2299
Practice Address - Country:US
Practice Address - Phone:301-682-1311
Practice Address - Fax:301-682-1311
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty