Provider Demographics
NPI:1790324960
Name:KOROMA, SAMUEL SULAIMAN (PMHNP)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:SULAIMAN
Last Name:KOROMA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PAUL MELLON CT STE 5
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2761
Mailing Address - Country:US
Mailing Address - Phone:301-810-4026
Mailing Address - Fax:
Practice Address - Street 1:101 PAUL MELLON CT STE 5
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2761
Practice Address - Country:US
Practice Address - Phone:301-810-4026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219005363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty