Provider Demographics
NPI:1083960041
Name:KOROMA, EDWARD (PRIMARY EDUCATION)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:KOROMA
Suffix:
Gender:M
Credentials:PRIMARY EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 CHESFORD RD SUITE # 2F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224
Mailing Address - Country:US
Mailing Address - Phone:614-563-5277
Mailing Address - Fax:
Practice Address - Street 1:4327 CHESFORD RD APT 2F
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1751
Practice Address - Country:US
Practice Address - Phone:614-563-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health