Healthcare Provider Details

I. General information

NPI: 1619888575
Provider Name (Legal Business Name): MR. ANTWON TRAMEL WASHINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 CRAIN HWY STE 205
WALDORF MD
20601-2816
US

IV. Provider business mailing address

2670 CRAIN HWY STE 205
WALDORF MD
20601-2816
US

V. Phone/Fax

Practice location:
  • Phone: 301-363-4900
  • Fax: 301-818-0110
Mailing address:
  • Phone: 301-363-4900
  • Fax: 301-818-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: