Provider Demographics
NPI:1568756070
Name:KOROMA-NELSON, MARIATU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIATU
Middle Name:
Last Name:KOROMA-NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3145
Mailing Address - Country:US
Mailing Address - Phone:703-717-7100
Mailing Address - Fax:703-717-4149
Practice Address - Street 1:3440 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3145
Practice Address - Country:US
Practice Address - Phone:703-717-7100
Practice Address - Fax:703-717-4149
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101256994207QG0300X, 207Q00000X
DCMD042492207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine