Healthcare Provider Details

I. General information

NPI: 1467380188
Provider Name (Legal Business Name): DERRICK BRADFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MAINE AVE SW APT E1224
WASHINGTON DC
20024-3447
US

IV. Provider business mailing address

1414 UPSHUR ST NW APT 308
WASHINGTON DC
20011-5555
US

V. Phone/Fax

Practice location:
  • Phone: 202-809-7529
  • Fax:
Mailing address:
  • Phone: 202-717-7898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: