MEDICARE: DAVID MCCRADY CRM, CRP

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	174H00000X	Health Educator	HE305
2	173C00000X	Reflexologist	EHB206

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EHB206	OTHER		HOLISTIC SERVICES AGENCY
2	HE305	OTHER		HOLISTIC SERVICES AGENCY

General Provider Information

NPI Number	:	1932699428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MCCRADY CRM, CRP

Provider Business Mailing Address
First Line	:	3700 MYSTIC CT
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-2457
Country	:	US
Telephone Number	:	240-350-8107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 CONNECTICUT AVE NW STE 1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-4500
Country	:	US
Telephone Number	:	202-686-8202
Fax Number	:

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

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/11/2018

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