Healthcare Provider Details

I. General information

NPI: 1093062085
Provider Name (Legal Business Name): ERIC RICARDO EXUM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 EDGEWOOD ST NE APARTMENT 411
WASHINGTON DC
20017-4145
US

IV. Provider business mailing address

635 EDGEWOOD ST NE APARTMENT 411
WASHINGTON DC
20017-4145
US

V. Phone/Fax

Practice location:
  • Phone: 202-200-5002
  • Fax:
Mailing address:
  • Phone: 202-200-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberH100057
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: