Provider Demographics
NPI:1750953428
Name:HUMPHREYS, MURTAADH
Entity type:Individual
Prefix:
First Name:MURTAADH
Middle Name:
Last Name:HUMPHREYS
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 1:1445 OTIS PL NW APT 128
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3208
Mailing Address - Country:US
Mailing Address - Phone:267-235-0789
Mailing Address - Fax:
Practice Address - Street 1:1845 HARVARD ST NW APT 309
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2324
Practice Address - Country:US
Practice Address - Phone:267-235-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant