Healthcare Provider Details

I. General information

NPI: 1164473872
Provider Name (Legal Business Name): RITA A MANFREDI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 L ST NW
WASHINGTON DC
20037-1527
US

IV. Provider business mailing address

2120 L ST NW
WASHINGTON DC
20037-1527
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-8804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101045882
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19159
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD42399
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number19159
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: