Provider Demographics
NPI:1417714205
Name:GEORGE, MARIAMA
Entity Type:Individual
Prefix:
First Name:MARIAMA
Middle Name:
Last Name:GEORGE
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 1:8792 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-9682
Mailing Address - Country:US
Mailing Address - Phone:301-728-0743
Mailing Address - Fax:
Practice Address - Street 1:10230 NEW HAMPSHIRE AVE # 340
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1400
Practice Address - Country:US
Practice Address - Phone:301-750-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF04230022363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care