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NPI Code Detail

MEDICARE: GREGORY MAURICE BAZEMORE

MEDICARE: GREGORY MAURICE BAZEMORE
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
11744P3200XProsthetics Case Management

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
183-1473231OTHERMDHAIR LOSS PRACTITIONER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558849034
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY MAURICE BAZEMORE
Provider Business Mailing Address
First Line : 3504 LESLIE AVE
Second Line :
City : TEMPLE HILLS
State : MD
Zip : 20748-4634
Country : US
Telephone Number : 703-955-2567
Fax Number :
Provider Business Practice Location Address
First Line : 3504 LESLIE AVE
Second Line :
City : TEMPLE HILLS
State : MD
Zip : 20748-4634
Country : US
Telephone Number : 703-955-2567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2018
Last Update Date : 08/06/2018

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Directions to “ GREGORY MAURICE BAZEMORE ” Practice Location

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