MEDICARE: GREGORY BOOKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1619792652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BOOKER

Provider Business Mailing Address
First Line	:	1440 EASTERN AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-8135
Country	:	US
Telephone Number	:	202-520-4996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1948 3RD ST NW APT 1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-1743
Country	:	US
Telephone Number	:	202-300-3318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2024
Last Update Date	:	11/15/2024

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Directions to “ GREGORY BOOKER ” Practice Location

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