Provider Demographics
NPI:1114267077
Name:KAMARA, ALPHA TEJAN
Entity Type:Individual
Prefix:MR
First Name:ALPHA
Middle Name:TEJAN
Last Name:KAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ALPHA
Other - Middle Name:TEJAN
Other - Last Name:KAMARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5028 57TH AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1620
Mailing Address - Country:US
Mailing Address - Phone:240-351-2586
Mailing Address - Fax:
Practice Address - Street 1:5028 57TH AVE
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-1630
Practice Address - Country:US
Practice Address - Phone:240-351-2586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103613171WH0202X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171WH0202XOther Service ProvidersContractorHome Modifications