MEDICARE: MEMUNATU BANGURA 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
1	2084P0800X	Psychiatry Physician	D0054387	MD

General Provider Information

NPI Number	:	1760409528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEMUNATU BANGURA M.D.

Provider Business Mailing Address
First Line	:	7100 CHESAPEAKE RD
Second Line	:	SUITE 201
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2349
Country	:	US
Telephone Number	:	301-459-8003
Fax Number	:	301-459-8005

Provider Business Practice Location Address
First Line	:	7100 CHESAPEAKE RD
Second Line	:	SUITE 201
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2349
Country	:	US
Telephone Number	:	301-459-8003
Fax Number	:	301-459-8005

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/28/2007

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