Healthcare Provider Details

I. General information

NPI: 1922842343
Provider Name (Legal Business Name): REBECCA CHARLES HOAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA CHARLES

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 ROSECROFT BLVD
FORT WASHINGTON MD
20744-3255
US

IV. Provider business mailing address

2002 ROSECROFT BLVD
FORT WASHINGTON MD
20744-3255
US

V. Phone/Fax

Practice location:
  • Phone: 240-495-8832
  • Fax:
Mailing address:
  • Phone: 240-495-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNAOOOO81018
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: