Healthcare Provider Details

I. General information

NPI: 1982928586
Provider Name (Legal Business Name): JONATHAN GLEN FLEURAT M.D., RMDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

IV. Provider business mailing address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

V. Phone/Fax

Practice location:
  • Phone: 202-853-1175
  • Fax:
Mailing address:
  • Phone: 202-853-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0077420
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101256020
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD042173
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: