Provider Demographics
NPI:1073149852
Name:TAMADOU, FATOUMATA
Entity Type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:
Last Name:TAMADOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FATOUMATA
Other - Middle Name:
Other - Last Name:TAMADOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENCE
Mailing Address - Street 1:4625 HORIZON CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4625 HORIZON CIR APT 102
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6801
Practice Address - Country:US
Practice Address - Phone:443-616-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4330372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD83-1062282OtherLEVEL 1
MD83-1062282Medicaid