Healthcare Provider Details

I. General information

NPI: 1982622809
Provider Name (Legal Business Name): POUNEH NOURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW PHC BUILDING, 6TH FLOOR
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 WISCONSIN AVE NW PHC BLDG
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-9183
  • Fax:
Mailing address:
  • Phone: 202-444-9183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0065108
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD035829
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: