MEDICARE: CHOUCHOUNA M KALAMBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R193970	MD

General Provider Information

NPI Number	:	1407580210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHOUCHOUNA M KALAMBA

Provider Business Mailing Address
First Line	:	3616 BYRON CIR
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7812
Country	:	US
Telephone Number	:	240-205-6310
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 BUCKEYSTOWN PIKE STE 308
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-8373
Country	:	US
Telephone Number	:	301-246-0423
Fax Number	:	301-637-3576

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2022
Last Update Date	:	09/24/2023

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Directions to “ CHOUCHOUNA M KALAMBA ” Practice Location

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