MEDICARE: BASIRU SAMBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R159377	MD
2	163WA2000X	Administrator Registered Nurse	R155931	MD
3	164W00000X	Licensed Practical Nurse	LP34564	MD
4	171M00000X	Case Manager/Care Coordinator
5	174400000X	Specialist
6	246Y00000X	Health Information Specialist/Technologist
7	247200000X	Other Technician
8	372500000X	Chore Provider
9	372600000X	Adult Companion
10	3747A0650X	Attendant Care Provider
11	374U00000X	Home Health Aide
12	376G00000X	Nursing Home Administrator
13	376J00000X	Homemaker
14	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1548636269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASIRU SAMBA

Provider Business Mailing Address
First Line	:	4802 WILLES VISION DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4671
Country	:	US
Telephone Number	:	301-284-0636
Fax Number	:	301-542-0184

Provider Business Practice Location Address
First Line	:	4802 WILLES VISION DR
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4671
Country	:	US
Telephone Number	:	301-284-0636
Fax Number	:	301-542-0184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	08/17/2015

Similar Medicare Providers

1831046796 — ANANGA ISAAC FOMINYAM
Practice Location Address:

4806 WILLES VISION DR
BOWIE, MD
20720-4671

Practice Phone: 512-797-4871
Practice Fax:

1124218110 — MRS. IRENE A ST PAUL CRNA
Practice Location Address:

4814 WILLES VISION DR
BOWIE, MD
20720-4671

Practice Phone: 973-666-1404
Practice Fax:

1750851234 — ODETTE NGUM FOMINYAM
Practice Location Address:

4806 WILLES VISION DR
BOWIE, MD
20720-4671

Practice Phone: 240-616-8239
Practice Fax:

1932707197 — CLARA AHAGHOTU
Practice Location Address:

13207 ARRIBA GREENFIELDS DR
BOWIE, MD
20720

Practice Phone: 301-675-7676
Practice Fax:

1467308825 — NUMENTE BEHAVIORAL HEALTH LLC
Practice Location Address:

12530 FAIRWOOD PKWY
BOWIE, MD
20720-6356

Practice Phone: 240-334-7393
Practice Fax:

1750238754 — MAIMUNA BARRIE
Practice Location Address:

12530 FAIRWOOD PKWY STE 102
BOWIE, MD
20720-6357

Practice Phone: 301-615-2111
Practice Fax:

Directions to “ BASIRU SAMBA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.