Provider Demographics
NPI:1699596650
Name:AKORO, GLAIN NWATI
Entity type:Individual
Prefix:
First Name:GLAIN
Middle Name:NWATI
Last Name:AKORO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CAPITAL CT APT 2206
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1092
Mailing Address - Country:US
Mailing Address - Phone:443-985-3173
Mailing Address - Fax:
Practice Address - Street 1:95 CAPITAL CT APT 2206
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-1092
Practice Address - Country:US
Practice Address - Phone:443-985-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MD171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker