Provider Demographics
NPI:1255847588
Name:BUMBARA MARK-IVO, KEM
Entity type:Individual
Prefix:MR
First Name:KEM
Middle Name:
Last Name:BUMBARA MARK-IVO
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 1:10016 ELLARD DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2051
Mailing Address - Country:US
Mailing Address - Phone:240-595-9915
Mailing Address - Fax:
Practice Address - Street 1:10016 ELLARD DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2051
Practice Address - Country:US
Practice Address - Phone:240-595-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator