Provider Demographics
NPI:1073219192
Name:CALLOWAY, REGINALD J
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:J
Last Name:CALLOWAY
Suffix:
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 1:621 RHODE ISLAND AVE NW # 23
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1854
Mailing Address - Country:US
Mailing Address - Phone:202-705-1259
Mailing Address - Fax:
Practice Address - Street 1:1400 29TH ST SE APT 15
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3658
Practice Address - Country:US
Practice Address - Phone:202-421-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant