Provider Demographics
NPI:1972075232
Name:KAMARA, ISHMAEL BAIMBA SR
Entity type:Individual
Prefix:
First Name:ISHMAEL
Middle Name:BAIMBA
Last Name:KAMARA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 67TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1760
Mailing Address - Country:US
Mailing Address - Phone:301-851-9066
Mailing Address - Fax:
Practice Address - Street 1:6011 67TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1760
Practice Address - Country:US
Practice Address - Phone:301-851-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14226374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide