Provider Demographics
NPI:1659971273
Name:BANGURA, MARY RAMATA
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RAMATA
Last Name:BANGURA
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 1:3475 LEONARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3678
Mailing Address - Country:US
Mailing Address - Phone:240-448-5653
Mailing Address - Fax:
Practice Address - Street 1:3475 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3678
Practice Address - Country:US
Practice Address - Phone:240-448-5653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide