Healthcare Provider Details

I. General information

NPI: 1508492190
Provider Name (Legal Business Name): STEPHEN SAMA GWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 NEW HAMPSHIRE AVE APT 1119
TAKOMA PARK MD
20912-6955
US

IV. Provider business mailing address

7401 NEW HAMPSHIRE AVE APT 1119
TAKOMA PARK MD
20912-6955
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-5344
  • Fax:
Mailing address:
  • Phone: 240-460-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA15034
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: