Healthcare Provider Details

I. General information

NPI: 1811258403
Provider Name (Legal Business Name): SAMUEL ENOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 WISCONSIN AVE NW SUITE 250
WASHINGTON DC
20016-4120
US

IV. Provider business mailing address

790 FAIRVIEW AVE #619
TAKOMA PARK MD
20912-5979
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-2400
  • Fax:
Mailing address:
  • Phone: 301-523-5506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: