Provider Demographics
NPI:1003411687
Name:ROOD, JONATHAN ALDEN JR
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALDEN
Last Name:ROOD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 ALABAMA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4912
Mailing Address - Country:US
Mailing Address - Phone:202-415-2428
Mailing Address - Fax:
Practice Address - Street 1:4519 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4912
Practice Address - Country:US
Practice Address - Phone:202-415-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide