Provider Demographics
NPI:1619371275
Name:KARGBO, ABDUL SR
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:KARGBO
Suffix:SR
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 1:5008 GLASSMANOR DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-2742
Mailing Address - Country:US
Mailing Address - Phone:301-379-4383
Mailing Address - Fax:
Practice Address - Street 1:5008 GLASSMANOR DR
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-2742
Practice Address - Country:US
Practice Address - Phone:301-379-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1004767164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse