MEDICARE: GREGORY DANIELS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1235789405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY DANIELS

Provider Business Mailing Address
First Line	:	4560 MACARTHUR BLVD NW APT 301
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-4272
Country	:	US
Telephone Number	:	443-425-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 HASTINGS DR
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-2621
Country	:	US
Telephone Number	:	301-898-6643
Fax Number	:

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

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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