Provider Demographics
NPI:1407580210
Name:KALAMBA, CHOUCHOUNA M
Entity Type:Individual
Prefix:
First Name:CHOUCHOUNA
Middle Name:M
Last Name:KALAMBA
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 1:3616 BYRON CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7812
Mailing Address - Country:US
Mailing Address - Phone:240-205-6310
Mailing Address - Fax:
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE STE 308
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8373
Practice Address - Country:US
Practice Address - Phone:301-246-0423
Practice Address - Fax:301-637-3576
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health