Provider Demographics
NPI:1205222569
Name:KOAUM, ALAIN
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:
Last Name:KOAUM
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 1:6122 BREEZEWOOD DR
Mailing Address - Street 2:APT 303
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1138
Mailing Address - Country:US
Mailing Address - Phone:301-547-9123
Mailing Address - Fax:
Practice Address - Street 1:6122 BREEZEWOOD DR
Practice Address - Street 2:APT 303
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1138
Practice Address - Country:US
Practice Address - Phone:301-547-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide