Provider Demographics
NPI:1639843865
Name:SQUIRE, THOMAS PATRICK II
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PATRICK
Last Name:SQUIRE
Suffix:II
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 1:6417 ROCK FOREST DR APT 104
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7859
Mailing Address - Country:US
Mailing Address - Phone:301-442-3179
Mailing Address - Fax:
Practice Address - Street 1:4201 BUTTERWORTH PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4538
Practice Address - Country:US
Practice Address - Phone:301-442-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant