Healthcare Provider Details

I. General information

NPI: 1932157146
Provider Name (Legal Business Name): ILENE S BUARQUE DE MACEDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 18TH STREET NW
WASHINGTON DC
20036
US

IV. Provider business mailing address

6305 MOUNTAIN BRANCH COURT
BETHESDA MD
20817
US

V. Phone/Fax

Practice location:
  • Phone: 202-785-2400
  • Fax: 202-452-1853
Mailing address:
  • Phone: 301-320-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD18813
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0040982
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: