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Individual

MR. KELLIE FAGBOWA MARAH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1010 WISCONSIN AVE NW, WASHINGTON, DC 20007-3603
(202) 955-8355
(703) 753-8793
Mailing address
6529 LANDOVER RD APT 102, CHEVERLY, MD 20785-1429
(240) 706-1658

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN1028482
DC
163WM0705X
Medical-Surgical Registered Nurse
R203641
MD
163WM0705X
Medical-Surgical Registered Nurse
Primary
RN1028482
DC

Other

Enumeration date
08/30/2016
Last updated
08/30/2016
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