Healthcare Provider Details

I. General information

NPI: 1245079128
Provider Name (Legal Business Name): CHARMAINE FORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 OLD FRANCONIA RD STE B
ALEXANDRIA VA
22310-2594
US

IV. Provider business mailing address

6180 OLD FRANCONIA RD STE B
ALEXANDRIA VA
22310-2594
US

V. Phone/Fax

Practice location:
  • Phone: 202-507-1889
  • Fax:
Mailing address:
  • Phone: 202-507-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: