Provider Demographics
NPI:1871373316
Name:EBULOH, FRITZ
Entity type:Individual
Prefix:
First Name:FRITZ
Middle Name:
Last Name:EBULOH
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 1:2410 SUSAN HODGES PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8945
Mailing Address - Country:US
Mailing Address - Phone:240-716-4638
Mailing Address - Fax:
Practice Address - Street 1:2410 SUSAN HODGES PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8945
Practice Address - Country:US
Practice Address - Phone:240-716-4638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator