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NPI Code Detail

MEDICARE: DR. MARIATU KOROMA-NELSON M.D.

MEDICARE: DR. MARIATU KOROMA-NELSON M.D.
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician0101256994VA

General Provider Information

NPI Number : 1568756070
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIATU KOROMA-NELSON M.D.
Provider Business Mailing Address
First Line : 3440 S JEFFERSON ST
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22041-3145
Country : US
Telephone Number : 703-717-7100
Fax Number : 703-717-4149
Provider Business Practice Location Address
First Line : 3440 S JEFFERSON ST
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22041-3145
Country : US
Telephone Number : 703-717-7100
Fax Number : 703-717-4149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2011
Last Update Date : 02/08/2021

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