Healthcare Provider Details

I. General information

NPI: 1114267077
Provider Name (Legal Business Name): MR. ALPHA TEJAN KAMARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. ALPHA TEJAN KAMARA

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 57TH AVE
BLADENSBURG MD
20710-1630
US

IV. Provider business mailing address

5028 57TH AVE APT 104
BLADENSBURG MD
20710-1620
US

V. Phone/Fax

Practice location:
  • Phone: 240-351-2586
  • Fax:
Mailing address:
  • Phone: 240-351-2586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number103613
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number103613
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: