Healthcare Provider Details

I. General information

NPI: 1285228452
Provider Name (Legal Business Name): FATIMA MUNA KOROMA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 OXON HILL RD # 1157
OXON HILL MD
20745-3108
US

IV. Provider business mailing address

9461 CHARLEVILLE BLVD STE 1216
BEVERLY HILLS CA
90212-3017
US

V. Phone/Fax

Practice location:
  • Phone: 301-265-5922
  • Fax: 475-275-7541
Mailing address:
  • Phone: 301-265-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC003679
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024181302
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95394117
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1063431
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: