Provider Demographics
NPI:1720439078
Name:WASHINGTON, ANTWONE LAMONTE
Entity Type:Individual
Prefix:
First Name:ANTWONE
Middle Name:LAMONTE
Last Name:WASHINGTON
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 1:10313 HORNTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-7034
Mailing Address - Country:US
Mailing Address - Phone:317-672-8509
Mailing Address - Fax:
Practice Address - Street 1:10313 HORNTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-7034
Practice Address - Country:US
Practice Address - Phone:317-672-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)