Healthcare Provider Details

I. General information

NPI: 1396637484
Provider Name (Legal Business Name): MARIANA BALTHAZAR NOGUEIRA PASSOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIANA BALTHAZAR NOGUEIRA MD

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

6607 LONE OAK DR
BETHESDA MD
20817-1649
US

V. Phone/Fax

Practice location:
  • Phone: 888-884-2327
  • Fax:
Mailing address:
  • Phone: 202-604-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMTL600211595
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: