Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2006-08-31
- Last updated
- 2023-06-24
Licenses
- License MO
- 2000157474
- License DC
- MD210002958
Location
- Practice location
- 900 23RD ST NW
- City
- WASHINGTON DC
- Postal code
- 200372342
- Phone
- 202-741-2750
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.