Provider Demographics
NPI:1467935999
Name:CARRIDICE, KADY ANDREA
Entity Type:Individual
Prefix:
First Name:KADY
Middle Name:ANDREA
Last Name:CARRIDICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1422
Mailing Address - Country:US
Mailing Address - Phone:347-264-0521
Mailing Address - Fax:
Practice Address - Street 1:1010 VERMONT AVE NE
Practice Address - Street 2:SUITE #1003
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:301-920-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid