Basic Information
| Provider Information | |||||||||
| NPI: | 1073157228 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BANGURA | ||||||||
| FirstName: | NADIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK RD | ||||||||
| Address2: | EXECUTIVE PLAZA 1, STE. 501 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7099148000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6355 WALKER LN STE 507 | ||||||||
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| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223103251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037384332 | ||||||||
| FaxNumber: | 7039714605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2019 | ||||||||
| LastUpdateDate: | 03/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.