Provider Demographics
NPI:1942634308
Name:NTIA, ISAAC J (HHA)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:J
Last Name:NTIA
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:ISAAC
Other - Middle Name:J
Other - Last Name:NTIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HHA
Mailing Address - Street 1:621 SHERIDAN ST APT 14
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3212
Mailing Address - Country:US
Mailing Address - Phone:240-413-5136
Mailing Address - Fax:
Practice Address - Street 1:621 SHERIDAN ST APT 14
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3212
Practice Address - Country:US
Practice Address - Phone:240-413-5136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2071103K00000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2071$$$$$$$$$OtherHHA