Provider Demographics
NPI:1760081152
Name:KOROMA, KADIATU
Entity Type:Individual
Prefix:
First Name:KADIATU
Middle Name:
Last Name:KOROMA
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 1:7729 HUBBLE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2498
Mailing Address - Country:US
Mailing Address - Phone:301-328-6151
Mailing Address - Fax:
Practice Address - Street 1:955 LENFANT PLZ SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2119
Practice Address - Country:US
Practice Address - Phone:202-895-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00128021376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD46203399100Medicaid