MEDICARE: MARTIN EFEUTFACK

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	374U00000X	Home Health Aide	HHA11885	DC

General Provider Information

NPI Number	:	1245690304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN EFEUTFACK

Provider Business Mailing Address
First Line	:	2104 COLUMBIA AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-4948
Country	:	US
Telephone Number	:	571-510-1024
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 COLUMBIA AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-4948
Country	:	US
Telephone Number	:	571-510-1024
Fax Number	:

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	03/02/2016

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Directions to “ MARTIN EFEUTFACK ” Practice Location

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