Healthcare Provider Details

I. General information

NPI: 1942024740
Provider Name (Legal Business Name): EUGENE ROSCOE PERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 55TH ST NE
WASHINGTON DC
20019-6784
US

IV. Provider business mailing address

928 SHARMA ST
CAPITOL HEIGHTS MD
20743-1776
US

V. Phone/Fax

Practice location:
  • Phone: 202-258-9100
  • Fax:
Mailing address:
  • Phone: 202-602-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: