Provider Demographics
NPI:1457239915
Name:KOROMA, MOHAMED
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:
Last Name:KOROMA
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 1:10102 GAYLEWINDS CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3169
Mailing Address - Country:US
Mailing Address - Phone:227-218-7192
Mailing Address - Fax:
Practice Address - Street 1:10102 GAYLEWINDS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-3169
Practice Address - Country:US
Practice Address - Phone:227-218-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-23
Last Update Date:2025-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)