Healthcare Provider Details

I. General information

NPI: 1164715926
Provider Name (Legal Business Name): MELISSA TERESA FAGONDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA TERESA FRANCO MD

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM STREET , NE DEPAUL 110
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1150 VARNUM ST NE RM 407
WASHINGTON DC
20017-2180
US

V. Phone/Fax

Practice location:
  • Phone: 202-448-4090
  • Fax: 202-448-4093
Mailing address:
  • Phone: 202-854-4090
  • Fax: 202-854-4093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD078399
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD042650
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: