Provider Demographics
NPI:1235613928
Name:DICKS, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:DICKS
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 1:902 FLORES ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1775
Mailing Address - Country:US
Mailing Address - Phone:202-684-1798
Mailing Address - Fax:
Practice Address - Street 1:1330 CONGRESS ST SE APT 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5073
Practice Address - Country:US
Practice Address - Phone:202-808-9211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant