Provider Demographics
NPI:1417650748
Name:MIDDLETON, ROY
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:MIDDLETON
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 1:7343 SHADY GLEN TER
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3468
Mailing Address - Country:US
Mailing Address - Phone:202-594-0210
Mailing Address - Fax:
Practice Address - Street 1:7343 SHADY GLEN TER
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3468
Practice Address - Country:US
Practice Address - Phone:202-594-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator