Provider Demographics
NPI:1447971023
Name:VINES, MALIK T
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:T
Last Name:VINES
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 1:63 HARRY S TRUMAN DR APT 13
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1028
Mailing Address - Country:US
Mailing Address - Phone:202-423-1998
Mailing Address - Fax:
Practice Address - Street 1:612 46TH PL SE APT 13
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7829
Practice Address - Country:US
Practice Address - Phone:202-423-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant