Healthcare Provider Details

I. General information

NPI: 1780499657
Provider Name (Legal Business Name): MAME KHOUREDIA NIANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2030 BOX 146
DPO AE
09283-0146
US

IV. Provider business mailing address

UNIT 2030 BOX 146
DPO AE
09283-0146
US

V. Phone/Fax

Practice location:
  • Phone: 202-913-8260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD0072362
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: