Provider Demographics
NPI:1154026318
Name:PRIMUS, COREY SEAN SR
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:SEAN
Last Name:PRIMUS
Suffix:SR
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 1:4545 42ND ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4623
Mailing Address - Country:US
Mailing Address - Phone:202-536-4414
Mailing Address - Fax:
Practice Address - Street 1:4545 42ND ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:202-536-4414
Practice Address - Fax:703-483-9963
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator