Individual
MR. DERICK L HAIRSTON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPT
Contact information
Practice address
612 LARCHMONT AVE, CAPITOL HEIGHTS, MD 20743-2839
(202) 910-2252
Mailing address
612 LARCHMONT AVE, BLOODWORKS, CAPITOL HEIGHTS, MD 20743-2839
(202) 910-2252
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
MD
Other
Enumeration date
12/19/2014
Last updated
01/09/2015
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