MEDICARE: MR. ISAAC J NTIA HHA

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	103K00000X	Behavior Analyst	2071	DC
2	320700000X	Physical Disabilities Residential Treatment Facility	2071	DC

General Provider Information

NPI Number	:	1942634308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ISAAC J NTIA HHA

Provider Business Mailing Address
First Line	:	621 SHERIDAN ST APT 14
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3212
Country	:	US
Telephone Number	:	240-413-5136
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 SHERIDAN ST APT 14
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3212
Country	:	US
Telephone Number	:	240-413-5136
Fax Number	:

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

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	07/21/2022

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