Provider Demographics
NPI:1265552954
Name:DOUGLASSHARPER, GERALD NELSON (NMD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:NELSON
Last Name:DOUGLASSHARPER
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:DR
Other - First Name:GERALD
Other - Middle Name:NELSON
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4205 58TH AVE
Mailing Address - Street 2:APT. 6
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-1910
Mailing Address - Country:US
Mailing Address - Phone:301-326-3515
Mailing Address - Fax:202-544-6820
Practice Address - Street 1:641 PENNSYLVANIA AVE SE
Practice Address - Street 2:STE. # 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4303
Practice Address - Country:US
Practice Address - Phone:202-544-4478
Practice Address - Fax:202-544-6820
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNAT 286175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath