Provider Demographics
NPI:1093407926
Name:MAFARA, MUSAVENGANA
Entity Type:Individual
Prefix:
First Name:MUSAVENGANA
Middle Name:
Last Name:MAFARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 CALVERT WAY
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-8583
Mailing Address - Country:US
Mailing Address - Phone:317-219-9701
Mailing Address - Fax:
Practice Address - Street 1:6001 CALVERT WAY
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-8583
Practice Address - Country:US
Practice Address - Phone:317-219-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDNRA140127251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health