Provider Demographics
NPI:1871934927
Name:FABO, BATOMEN MARCELLE I (D)
Entity type:Individual
Prefix:MISS
First Name:BATOMEN
Middle Name:MARCELLE
Last Name:FABO
Suffix:I
Gender:F
Credentials:D
Other - Prefix:MISS
Other - First Name:BATOMEN
Other - Middle Name:MARCELLE
Other - Last Name:FABO
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:D
Mailing Address - Street 1:1210 MYRTLE AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6506
Mailing Address - Country:US
Mailing Address - Phone:561-306-0988
Mailing Address - Fax:
Practice Address - Street 1:6733 NEW HAMPSHIRE
Practice Address - Street 2:#509
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:561-306-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA6918251E00000X, 302R00000X
HHA6918374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization