Provider Demographics
NPI:1225600224
Name:KAMARA, KADIATU TOM
Entity Type:Individual
Prefix:
First Name:KADIATU
Middle Name:TOM
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 1:3300 TEAGARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7502
Mailing Address - Country:US
Mailing Address - Phone:240-476-5442
Mailing Address - Fax:410-946-2010
Practice Address - Street 1:3300 TEAGARDEN CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7502
Practice Address - Country:US
Practice Address - Phone:240-476-5442
Practice Address - Fax:410-946-2010
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00056974376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide