Provider Demographics
NPI:1932275344
Name:WASHINGTON, EDWARD HOLT JR (D C)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:HOLT
Last Name:WASHINGTON
Suffix:JR
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2172
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-2172
Mailing Address - Country:US
Mailing Address - Phone:919-286-9430
Mailing Address - Fax:919-286-3624
Practice Address - Street 1:623 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4832
Practice Address - Country:US
Practice Address - Phone:919-286-9430
Practice Address - Fax:919-286-3624
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244373COtherPTAN
NC244373COtherPTAN
NC8908909Medicaid