Healthcare Provider Details

I. General information

NPI: 1518081645
Provider Name (Legal Business Name): KEISHA EVON ROBINSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-1548
US

IV. Provider business mailing address

1220 12TH ST SE SUITE 120
WASHINGTON DC
20003-3722
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-1800
  • Fax: 202-279-4943
Mailing address:
  • Phone: 202-715-7900
  • Fax: 202-232-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO034160
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: