Healthcare Provider Details

I. General information

NPI: 1750201604
Provider Name (Legal Business Name): MARIAM COULIBALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 NEW HAMPSHIRE AVE APT 1111
TAKOMA PARK MD
20912-2861
US

IV. Provider business mailing address

6733 NEW HAMPSHIRE AVE APT 1111
TAKOMA PARK MD
20912-2861
US

V. Phone/Fax

Practice location:
  • Phone: 240-424-3800
  • Fax:
Mailing address:
  • Phone: 240-424-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006779
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: