Provider Demographics
NPI:1427815760
Name:WAUGH, KEVIN D
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:WAUGH
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 1:2101 ARBOR HILL LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1525
Mailing Address - Country:US
Mailing Address - Phone:202-751-6135
Mailing Address - Fax:
Practice Address - Street 1:2101 ARBOR HILL LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1525
Practice Address - Country:US
Practice Address - Phone:202-751-6135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant