Healthcare Provider Details

I. General information

NPI: 1952976771
Provider Name (Legal Business Name): ADVANCE INTEGRATED HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PAUL MELLON CT STE 5
WALDORF MD
20602-2761
US

IV. Provider business mailing address

101 PAUL MELLON CT STE 5
WALDORF MD
20602-2761
US

V. Phone/Fax

Practice location:
  • Phone: 301-810-4026
  • Fax:
Mailing address:
  • Phone: 301-810-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL SULAIMAN KOROMA
Title or Position: OWNER
Credential: CRNP-PMH
Phone: 301-810-4026