Provider Demographics
NPI:1619778297
Name:KOME, KARENT EJELLE
Entity type:Individual
Prefix:
First Name:KARENT
Middle Name:EJELLE
Last Name:KOME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KARENT
Other - Middle Name:EJELLE
Other - Last Name:KOME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3513 SHARONWOOD RD APT 3B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-5900
Mailing Address - Country:US
Mailing Address - Phone:240-927-9153
Mailing Address - Fax:
Practice Address - Street 1:9500 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-3701
Practice Address - Country:US
Practice Address - Phone:240-334-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator