Provider Demographics
NPI:1750814539
Name:PERKINS, KEVIN JOEL
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JOEL
Last Name:PERKINS
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 1:15214 NANCY GIBBONS TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8063
Mailing Address - Country:US
Mailing Address - Phone:202-460-7772
Mailing Address - Fax:
Practice Address - Street 1:15214 NANCY GIBBONS TER
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8063
Practice Address - Country:US
Practice Address - Phone:202-460-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant