Individual
DR. EASTON L MANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1140 VARNUM ST NE STE 207, WASHINGTON, DC 20017-2153
(202) 526-5300
(202) 526-6013
Mailing address
1140 VARNUM ST NE STE 207, WASHINGTON, DC 20017-2153
(202) 526-5300
(202) 526-6013
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD6154
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021189900
—
DC
05
—
042893900
—
DC
01
—
DE6844 200036987
RAILROAD MEDICARE
GA
01
—
F921 0001
CAREFIRST
DC
Enumeration date
07/02/2006
Last updated
01/23/2020
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