Provider Demographics
NPI:1255058095
Name:KAMARA, AMARA M
Entity type:Individual
Prefix:
First Name:AMARA
Middle Name:M
Last Name:KAMARA
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 1:134 CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3831
Mailing Address - Country:US
Mailing Address - Phone:347-443-9636
Mailing Address - Fax:
Practice Address - Street 1:134 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3831
Practice Address - Country:US
Practice Address - Phone:347-443-9636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA65143601376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1040564000001Medicaid