MEDICARE: DR. GERALD NELSON DOUGLASSHARPER NMD

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	175F00000X	Naturopath	NAT 286	DC

General Provider Information

NPI Number	:	1265552954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD NELSON DOUGLASSHARPER NMD

Provider Business Mailing Address
First Line	:	4205 58TH AVE
Second Line	:	APT. 6
City	:	BLADENSBURG
State	:	MD
Zip	:	20710-1910
Country	:	US
Telephone Number	:	301-326-3515
Fax Number	:	202-544-6820

Provider Business Practice Location Address
First Line	:	641 PENNSYLVANIA AVE SE
Second Line	:	STE. # 1
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4303
Country	:	US
Telephone Number	:	202-544-4478
Fax Number	:	202-544-6820

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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