Healthcare Provider Details

I. General information

NPI: 1760803480
Provider Name (Legal Business Name): JOHN KENTON DESMARTEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 MASSACHUSETTS AVE NW
WASHINGTON DC
20016-2361
US

IV. Provider business mailing address

4651 MASSACHUSETTS AVE NW
WASHINGTON DC
20016-2361
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-2719
  • Fax: 202-558-6742
Mailing address:
  • Phone: 202-237-2719
  • Fax: 202-558-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberMD034913
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD034913
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: