Healthcare Provider Details

I. General information

NPI: 1114168341
Provider Name (Legal Business Name): MEDICAL FACULTY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW SUITE 10-407
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW SUITE 10-407
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3375
  • Fax: 202-741-3396
Mailing address:
  • Phone: 202-741-3375
  • Fax: 202-741-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1672
License Number StateDC

VIII. Authorized Official

Name: MISS MARK TATELBAUM
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 202-741-3375