Individual
GREGORY MAURICE BAZEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3504 LESLIE AVE, TEMPLE HILLS, MD 20748-4634
(703) 955-2567
Mailing address
3504 LESLIE AVE, TEMPLE HILLS, MD 20748-4634
(703) 955-2567
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83-1473231
HAIR LOSS PRACTITIONER
MD
05
—
83-1473231
—
MD
Enumeration date
08/06/2018
Last updated
08/06/2018
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