MEDICARE: KATREIA CHAREECE WHITE

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	1744P3200X	Prosthetics Case Management		MD

General Provider Information

NPI Number	:	1477153633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATREIA CHAREECE WHITE

Provider Business Mailing Address
First Line	:	6800 ATWOOD ST APT 5
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-1621
Country	:	US
Telephone Number	:	202-714-1005
Fax Number	:

Provider Business Practice Location Address
First Line	:	5612 SAINT BARNABAS RD
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-3626
Country	:	US
Telephone Number	:	202-714-1005
Fax Number	:

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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Directions to “ KATREIA CHAREECE WHITE ” Practice Location

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