Healthcare Provider Details

I. General information

NPI: 1407763519
Provider Name (Legal Business Name): ACADEMIC EMERGENCY MEDICINE PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-5700
US

IV. Provider business mailing address

PO BOX 3149
INDIANAPOLIS IN
46206-3149
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4444
  • Fax:
Mailing address:
  • Phone: 469-420-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL LEE
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 202-741-2904