Provider Demographics
NPI:1972096071
Name:NAMBA, DARYAN REI (MD)
Entity Type:Individual
Prefix:MRS
First Name:DARYAN
Middle Name:REI
Last Name:NAMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14901 BROCHART ROAD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-251-4500
Mailing Address - Fax:803-434-4062
Practice Address - Street 1:12301 ACADEMY WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-984-4444
Practice Address - Fax:301-881-8043
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL526582084P0800X
MDD00967302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD768141100Medicaid