Healthcare Provider Details

I. General information

NPI: 1295189181
Provider Name (Legal Business Name): KSENYA KONSTANTINOVNA BADASHOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 L ST NW STE 450
WASHINGTON DC
20037-1541
US

IV. Provider business mailing address

2120 L ST NW STE 450
WASHINGTON DC
20037-1541
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD047204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: