Healthcare Provider Details

I. General information

NPI: 1225965502
Provider Name (Legal Business Name): MR. KEVIN KADEEM PEARCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DIVISION AVE NE
WASHINGTON DC
20019-5457
US

IV. Provider business mailing address

7603 LAKE GLEN DR
GLENN DALE MD
20769-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-204-1361
  • Fax:
Mailing address:
  • Phone: 301-674-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: