Provider Demographics
NPI:1487314746
Name:ALSTON, MICHAEL ANTONIO
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTONIO
Last Name:ALSTON
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 1:1924 RIDGECREST CT SE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6211
Mailing Address - Country:US
Mailing Address - Phone:202-285-0740
Mailing Address - Fax:
Practice Address - Street 1:2 M ST NE APT 1129
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3993
Practice Address - Country:US
Practice Address - Phone:202-480-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant