Provider Demographics
NPI:1609629062
Name:KOROMA, ABASS
Entity Type:Individual
Prefix:
First Name:ABASS
Middle Name:
Last Name:KOROMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREAT VALLEY PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1426
Mailing Address - Country:US
Mailing Address - Phone:484-602-1295
Mailing Address - Fax:
Practice Address - Street 1:5 GREAT VALLEY PKWY STE 210
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1426
Practice Address - Country:US
Practice Address - Phone:484-602-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7642E374990C4C3FBD57374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide