Individual provider · NPI-1

Elijah Byrd

Student in an Organized Health Care Education/Training Program · Bowie, MD

NPI number1629938212
StatusActive
Last updated in NPPESNov 14, 2025

Details

NPI
1629938212
Entity type
Individual (NPI-1)
Name
Elijah Byrd
Sex
Male
Sole proprietor
Yes
Enumeration date
Nov 14, 2025
Certification date
Nov 14, 2025
Last updated
Nov 14, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
390200000X Student in an Organized Health Care Education/Training Program––Yes

Practice location

12003 Lofting Ct
Bowie, MD 20720-4462

Phone 301-437-0396

Mailing address

12003 Lofting Ct
Bowie, MD 20720-4462

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