Individual
DR. ELWIN G BUSTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 VARNUM ST NE STE 202, WASHINGTON, DC 20017-2153
(202) 269-6430
(202) 269-6598
Mailing address
1140 VARNUM ST NE STE 202, WASHINGTON, DC 20017-2153
(202) 269-6430
(202) 269-6598
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD19909
DC
261QP2300X
Primary Care Clinic/Center
MD19909
DC
302R00000X
Health Maintenance Organization
0101048655
VA
302R00000X
Health Maintenance Organization
MD19909
DC
305R00000X
Preferred Provider Organization
0101048655
VA
305R00000X
Preferred Provider Organization
D0042936
MD
305R00000X
Preferred Provider Organization
MD19909
DC
305S00000X
Point of Service
MD19909
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011630100
—
DC
01
—
0401616
EVERCARE MARYLAND
—
05
—
055092400
—
DC
01
—
09D0948025
CLIA
DC
01
—
1059
ELDER HEALTH
—
01
—
110167563
RAILROAD
—
01
—
44320001
BCBSHIELD
—
01
—
541897047
ALL OTHER INSURANCES
—
05
—
825900200
—
MD
01
—
96121
AMERIGROUP
—
01
—
S10081
CHARTERED HEALTH PLAN
—
Enumeration date
09/27/2006
Last updated
10/03/2025
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