Healthcare Provider Details

I. General information

NPI: 1407686710
Provider Name (Legal Business Name): REGINA MICHELLE CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE STE 401
WASHINGTON DC
20020-7021
US

IV. Provider business mailing address

2671 DOUGLASS RD SE APT 103
WASHINGTON DC
20020-6591
US

V. Phone/Fax

Practice location:
  • Phone: 202-536-4414
  • Fax: 703-483-9928
Mailing address:
  • Phone: 202-465-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: