Provider Demographics
NPI:1063274769
Name:MCBRIDE, RAIFORD CEDRIC JR
Entity type:Individual
Prefix:
First Name:RAIFORD
Middle Name:CEDRIC
Last Name:MCBRIDE
Suffix:JR
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 1:4705 PARD RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5265
Mailing Address - Country:US
Mailing Address - Phone:202-569-1030
Mailing Address - Fax:
Practice Address - Street 1:5300 E CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6611
Practice Address - Country:US
Practice Address - Phone:240-522-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant