Provider Demographics
NPI:1871928101
Name:PRINSTON, MYRIAM A (OTR)
Entity type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:A
Last Name:PRINSTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 QUETZAL DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4347
Mailing Address - Country:US
Mailing Address - Phone:202-427-7016
Mailing Address - Fax:
Practice Address - Street 1:409 BUTTERNUT STREET NW SUITE 1
Practice Address - Street 2:
Practice Address - City:WASH
Practice Address - State:DC
Practice Address - Zip Code:20012-1925
Practice Address - Country:US
Practice Address - Phone:202-437-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT725171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC225XP0200XMedicaid