MEDICARE: MR. ROOSEVELT MILTON JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1023378270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROOSEVELT MILTON JR.

Provider Business Mailing Address
First Line	:	3800 POWELL LN APT 530
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-3664
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 POWELL LN APT 530
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-3664
Country	:	US
Telephone Number	:	703-434-2713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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Directions to “ MR. ROOSEVELT MILTON JR. ” Practice Location

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