Individual
WACCA MERID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5727 16TH ST NW, WASHINGTON, DC 20011-6815
(202) 882-8255
(202) 882-8255
Mailing address
5727 16TH ST NW, WASHINGTON, DC 20011-6815
(202) 882-8255
(202) 882-8255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101231257
VA
207R00000X
Internal Medicine Physician
Primary
D0057737
MD
207R00000X
Internal Medicine Physician
MD33293
DC
Other
Enumeration date
07/19/2007
Last updated
07/19/2007
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