Healthcare Provider Details

I. General information

NPI: 1205222569
Provider Name (Legal Business Name): ALAIN KOAUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 BREEZEWOOD DR APT 303
GREENBELT MD
20770-1138
US

IV. Provider business mailing address

6122 BREEZEWOOD DR APT 303
GREENBELT MD
20770-1138
US

V. Phone/Fax

Practice location:
  • Phone: 301-547-9123
  • Fax:
Mailing address:
  • Phone: 301-547-9123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: