Healthcare Provider Details

I. General information

NPI: 1700011947
Provider Name (Legal Business Name): ANACOSTIA RIVER EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

13737 NOEL ROAD STE 1600
DALLAS TX
75240
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-6000
  • Fax: 215-957-2875
Mailing address:
  • Phone: 469-401-2386
  • Fax: 214-712-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD45941
License Number StateMD

VIII. Authorized Official

Name: RUSSELL HARRIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 469-401-2386