Healthcare Provider Details

I. General information

NPI: 1427180538
Provider Name (Legal Business Name): GENERATION INCORPORTATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 FAWN CT
WALDORF MD
20602-2222
US

IV. Provider business mailing address

2175 FAWN CT
WALDORF MD
20602-2222
US

V. Phone/Fax

Practice location:
  • Phone: 202-360-2224
  • Fax: 240-222-3782
Mailing address:
  • Phone: 202-360-2224
  • Fax: 240-222-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number200044
License Number StateDC

VIII. Authorized Official

Name: MR. WILBUR DWIGHT WILSON JR.
Title or Position: PRESIDENT
Credential:
Phone: 202-360-2224