Healthcare Provider Details

I. General information

NPI: 1841401676
Provider Name (Legal Business Name): SPRING VALLEY OBGYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW SUITE 307
WASHINGTON DC
20016-4300
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW SUITE 307
WASHINGTON DC
20016-4300
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-8633
  • Fax: 202-237-8632
Mailing address:
  • Phone: 202-237-8633
  • Fax: 202-237-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD20701
License Number StateDC

VIII. Authorized Official

Name: DR. MALCOLM MARK DESOUZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 202-237-8633