Healthcare Provider Details

I. General information

NPI: 1356968853
Provider Name (Legal Business Name): BROOKE ELIZABETH MCDONALD CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

201 I ST NE APT 616
WASHINGTON DC
20002-4466
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2025
  • Fax:
Mailing address:
  • Phone: 513-295-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberAA000130
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: