Provider Demographics
NPI:1114503117
Name:KAMARA, KALLATOR
Entity Type:Individual
Prefix:
First Name:KALLATOR
Middle Name:
Last Name:KAMARA
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 1:11700 OLD COLUMBIA PIKE APT 1716
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2557
Mailing Address - Country:US
Mailing Address - Phone:240-646-2169
Mailing Address - Fax:410-946-2010
Practice Address - Street 1:11700 OLD COLUMBIA PIKE APT 1716
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2557
Practice Address - Country:US
Practice Address - Phone:240-646-2169
Practice Address - Fax:410-946-2010
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00126042376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide