Provider Demographics
NPI:1083078372
Name:PARAMOLE, IDRIS
Entity Type:Individual
Prefix:
First Name:IDRIS
Middle Name:
Last Name:PARAMOLE
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 1:6409 LANDOVER RD
Mailing Address - Street 2:APT 102
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1406
Mailing Address - Country:US
Mailing Address - Phone:301-851-9896
Mailing Address - Fax:
Practice Address - Street 1:6409 LANDOVER RD
Practice Address - Street 2:APT 102
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1406
Practice Address - Country:US
Practice Address - Phone:301-851-9896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11753390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
064071499OtherHOME HEALTH AIDE