Healthcare Provider Details

I. General information

NPI: 1760714935
Provider Name (Legal Business Name): ROY LEIBOFF, M.D. & GEORGE BREN, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 M ST NW SUITE 314
WASHINGTON DC
20037-1404
US

IV. Provider business mailing address

2440 M ST NW SUITE 314
WASHINGTON DC
20037-1404
US

V. Phone/Fax

Practice location:
  • Phone: 202-785-4966
  • Fax: 202-728-0905
Mailing address:
  • Phone: 202-785-4966
  • Fax: 202-728-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD11927
License Number StateDC

VIII. Authorized Official

Name: JUDY SYLVESTER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 301-868-8024