Provider Demographics
NPI:1104453430
Name:PROUT, DARA BURGETTE
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:BURGETTE
Last Name:PROUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NOTTINGHILL CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1929
Mailing Address - Country:US
Mailing Address - Phone:410-302-8365
Mailing Address - Fax:
Practice Address - Street 1:4201 BUTTERWORTH PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4538
Practice Address - Country:US
Practice Address - Phone:202-450-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant