Provider Demographics
NPI:1548959356
Name:KAMWA SIMO, ELTON BARREL
Entity type:Individual
Prefix:
First Name:ELTON
Middle Name:BARREL
Last Name:KAMWA SIMO
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 1:10101 GREENSPIRE WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2714
Mailing Address - Country:US
Mailing Address - Phone:240-463-5244
Mailing Address - Fax:
Practice Address - Street 1:2526 PENNSYLVAINA AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6729
Practice Address - Country:US
Practice Address - Phone:202-748-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator