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General NPI Number Information
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NPI Number | 1699231563
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Entity Type | Individual
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Provider Name | SAMORA CHARLES LUNGU
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Gender | Female
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD STE 506
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City | BETHESDA
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State | MD
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Zip | 20817-1184
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Country | US
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Telephone | 301-530-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE FL 2
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA200001321
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C07477
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License Number State | MD
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