Healthcare Provider Details

I. General information

NPI: 1376606624
Provider Name (Legal Business Name): DAN TALIAFERRO BRODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 400
WASHINGTON DC
20006-1009
US

IV. Provider business mailing address

2021 K ST NW STE 400
WASHINGTON DC
20006-1009
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-3500
  • Fax: 202-833-3503
Mailing address:
  • Phone: 202-833-3500
  • Fax: 202-833-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMD30725
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD30725
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: