Individual
ALIMATU MARY BANGURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7700 LITTLE RIVER TPKE STE 305, ANNANDALE, VA 22003-2406
(240) 618-9820
Mailing address
7700 LITTLE RIVER TPKE STE 305, ANNANDALE, VA 22003-2406
(240) 618-9820
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699725143
MODIVCARE
VA
05
—
MEDICAID
—
VA
Enumeration date
05/16/2023
Last updated
05/16/2023
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