Provider Demographics
NPI:1760409528
Name:BANGURA, MEMUNATU (MD)
Entity Type:Individual
Prefix:
First Name:MEMUNATU
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 CHESAPEAKE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2349
Mailing Address - Country:US
Mailing Address - Phone:301-459-8003
Mailing Address - Fax:301-459-8005
Practice Address - Street 1:7100 CHESAPEAKE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2349
Practice Address - Country:US
Practice Address - Phone:301-459-8003
Practice Address - Fax:301-459-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00543872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC004720A75Medicare PIN
MDH04173Medicare UPIN