1508006081 NPI number — GEORGETOWN DERMATOLOGY PLLC

Table of content: (NPI 1508006081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508006081 NPI number — GEORGETOWN DERMATOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGETOWN DERMATOLOGY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508006081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 NEW MEXICO AVE NW
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20016-3622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-363-9600
Provider Business Mailing Address Fax Number:
202-363-9601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 NEW MEXICO AVE NW
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-3622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-363-9600
Provider Business Practice Location Address Fax Number:
202-363-9601
Provider Enumeration Date:
02/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KAUFFMAN
Authorized Official First Name:
CATHARINE LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
202-270-3620

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)