Provider Demographics
NPI:1265040455
Name:KOROMA, ALIMIE (LPN)
Entity Type:Individual
Prefix:MR
First Name:ALIMIE
Middle Name:
Last Name:KOROMA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 APPLEDOWRE CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5513
Mailing Address - Country:US
Mailing Address - Phone:301-537-2883
Mailing Address - Fax:
Practice Address - Street 1:6120 KANSAS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-829-1719
Practice Address - Fax:202-722-4719
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLP1005745164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
901969194OtherCARE FIRST BLUECHOICE