Provider Demographics
NPI:1992468565
Name:KAMARA, MAMOUD B
Entity Type:Individual
Prefix:
First Name:MAMOUD
Middle Name:B
Last Name:KAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 GREENBELT RD APT 203
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2229
Mailing Address - Country:US
Mailing Address - Phone:646-804-5258
Mailing Address - Fax:
Practice Address - Street 1:2606 18TH ST SE # THSTSEC
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3259
Practice Address - Country:US
Practice Address - Phone:706-621-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMTO138340374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician