Provider Demographics
NPI:1659813038
Name:KARGBO, SOLOMON (CNA)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:
Last Name:KARGBO
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10804 GLENSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9150
Mailing Address - Country:US
Mailing Address - Phone:301-277-4337
Mailing Address - Fax:301-277-4335
Practice Address - Street 1:10804 GLENSHIRE DR
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9150
Practice Address - Country:US
Practice Address - Phone:301-277-4337
Practice Address - Fax:301-277-4335
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA001106453747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant