Provider Demographics
NPI:1730747346
Name:FLEMONS, QUENTIN AVERY
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:AVERY
Last Name:FLEMONS
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 1:4850 CONNECTICUT AVE NW APT 426
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5904
Mailing Address - Country:US
Mailing Address - Phone:202-629-6413
Mailing Address - Fax:
Practice Address - Street 1:3459 MINNESOTA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2378
Practice Address - Country:US
Practice Address - Phone:202-845-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3558737Medicaid