Provider Demographics
NPI:1427720291
Name:KABUGA, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:KABUGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 STONEWAY PL
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4809
Mailing Address - Country:US
Mailing Address - Phone:443-653-7837
Mailing Address - Fax:
Practice Address - Street 1:54 STONEWAY PL
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4809
Practice Address - Country:US
Practice Address - Phone:443-653-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO736376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator