Provider Demographics
NPI:1316437999
Name:EPIE, ETOTO V
Entity type:Individual
Prefix:
First Name:ETOTO
Middle Name:V
Last Name:EPIE
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 1:1220 12TH ST SE STE G35
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3738
Mailing Address - Country:US
Mailing Address - Phone:202-544-8090
Mailing Address - Fax:202-544-8091
Practice Address - Street 1:6522 EDGERTON DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3515
Practice Address - Country:US
Practice Address - Phone:240-305-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13689374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide