Healthcare Provider Details

I. General information

NPI: 1962319921
Provider Name (Legal Business Name): ABRAHAM DURAID EYSA JEFFERSON NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9923 GABLE RIDGE TER APT N
ROCKVILLE MD
20850-4656
US

IV. Provider business mailing address

9923 GABLE RIDGE TER APT N
ROCKVILLE MD
20850-4656
US

V. Phone/Fax

Practice location:
  • Phone: 540-654-0553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5073810
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: