Healthcare Provider Details

I. General information

NPI: 1659831626
Provider Name (Legal Business Name): CYRELLE ELIZE FERMIN FINAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

5632 OLD MILL RD
ALEXANDRIA VA
22309-3332
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5694
  • Fax:
Mailing address:
  • Phone: 703-362-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD210011590
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: