Provider Demographics
NPI:1487464913
Name:CROCKER, DAVID E
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:CROCKER
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 1:1511 MORRIS RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4412
Mailing Address - Country:US
Mailing Address - Phone:202-808-5712
Mailing Address - Fax:
Practice Address - Street 1:4020 MINNESOTA AVE. S.E.
Practice Address - Street 2:402
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2001
Practice Address - Country:US
Practice Address - Phone:202-808-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DC374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide