Healthcare Provider Details

I. General information

NPI: 1093072175
Provider Name (Legal Business Name): MARCEL A ATASHIMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 28TH PL APT# 4
MOUNT RAINIER MD
20712-1527
US

IV. Provider business mailing address

4310 28TH PL APT# 4
MOUNT RAINIER MD
20712-1527
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-1725
  • Fax:
Mailing address:
  • Phone:
  • 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: