Provider Demographics
NPI:1275280778
Name:YATHEU, MARTIAL
Entity Type:Individual
Prefix:
First Name:MARTIAL
Middle Name:
Last Name:YATHEU
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 1:7600 GEORGIA AVE NW STE 316
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1639
Mailing Address - Country:US
Mailing Address - Phone:202-621-8304
Mailing Address - Fax:
Practice Address - Street 1:1131 UNIVERSITY BLVD W APT 2006
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3336
Practice Address - Country:US
Practice Address - Phone:240-467-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide