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Individual

MR. ABDUL-MALIK JALLOH-JAMBORIA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
(301) 665-1717
(301) 665-1810
Mailing address
PO BOX 1248, HAGERSTOWN, MD 21741-1248
(800) 938-2828
(302) 733-0854

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R172198
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
085722
AANA ID
MD
01
P00957554
RAILROAD MEDICARE PTAN
MD
Enumeration date
01/19/2011
Last updated
11/30/2012
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