Individual
KENNETH U MBACHU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
900 CATON AVE, BALTIMORE, MD 21229-5201
(410) 368-2414
Mailing address
900 CATON AVE, BALTIMORE, MD 21229-5201
(410) 368-2414
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0002548
MD
Other
Enumeration date
04/01/2006
Last updated
09/16/2013
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