MEDICARE: DEBORAH KOROMA FNP

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	363LF0000X	Family Nurse Practitioner	R192395	MD

General Provider Information

NPI Number	:	1780982066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KOROMA FNP

Provider Business Mailing Address
First Line	:	16204 PENTERRA WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-1919
Country	:	US
Telephone Number	:	240-432-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 CENTRAL AVE STE 302A
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-4853
Country	:	US
Telephone Number	:	301-613-9295
Fax Number	:

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	01/07/2020

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