Provider Demographics
NPI:1093062085
Name:EXUM, ERIC RICARDO
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RICARDO
Last Name:EXUM
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 1:635 EDGEWOOD ST NE
Mailing Address - Street 2:APARTMENT 411
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-4145
Mailing Address - Country:US
Mailing Address - Phone:202-200-5002
Mailing Address - Fax:
Practice Address - Street 1:635 EDGEWOOD ST NE
Practice Address - Street 2:APARTMENT 411
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4145
Practice Address - Country:US
Practice Address - Phone:202-200-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
DCH100057374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide