Provider Demographics
NPI:1881170546
Name:JALLOW, BABOUCARR
Entity type:Individual
Prefix:
First Name:BABOUCARR
Middle Name:
Last Name:JALLOW
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 1:2647 HYDRAULIC RD APT F
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2321
Mailing Address - Country:US
Mailing Address - Phone:540-827-8892
Mailing Address - Fax:
Practice Address - Street 1:2647 HYDRAULIC RD APT F
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2321
Practice Address - Country:US
Practice Address - Phone:540-827-8892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVWT-2561347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle