Provider Demographics
NPI:1174104889
Name:JOE, JERRON RASHAD
Entity type:Individual
Prefix:
First Name:JERRON
Middle Name:RASHAD
Last Name:JOE
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 1:4637 TOWNE PARK RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1608
Mailing Address - Country:US
Mailing Address - Phone:202-280-0896
Mailing Address - Fax:
Practice Address - Street 1:4637 TOWNE PARK RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1608
Practice Address - Country:US
Practice Address - Phone:202-280-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant