Provider Demographics
NPI:1104303288
Name:CAMARA, ALAGIE
Entity type:Individual
Prefix:
First Name:ALAGIE
Middle Name:
Last Name:CAMARA
Suffix:
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 1:1500 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-3935
Mailing Address - Country:US
Mailing Address - Phone:301-801-4718
Mailing Address - Fax:
Practice Address - Street 1:1500 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-3935
Practice Address - Country:US
Practice Address - Phone:301-801-4718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP50100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse