Healthcare Provider Details

I. General information

NPI: 1982518122
Provider Name (Legal Business Name): MR. IMAN ZHANE BLACKMON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N CAPITOL ST NE APT 307
WASHINGTON DC
20002-8958
US

IV. Provider business mailing address

949 1ST ST SE APT 550
WASHINGTON DC
20003-4758
US

V. Phone/Fax

Practice location:
  • Phone: 202-718-3592
  • Fax:
Mailing address:
  • Phone: 202-718-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: