Provider Demographics
NPI:1932699428
Name:MCCRADY, DAVID (CRM, CRP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MCCRADY
Suffix:
Gender:M
Credentials:CRM, CRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MYSTIC CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2457
Mailing Address - Country:US
Mailing Address - Phone:240-350-8107
Mailing Address - Fax:
Practice Address - Street 1:3701 CONNECTICUT AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-4500
Practice Address - Country:US
Practice Address - Phone:202-686-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HE305174H00000X
EHB206173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
EHB206OtherHOLISTIC SERVICES AGENCY
HE305OtherHOLISTIC SERVICES AGENCY