Healthcare Provider Details

I. General information

NPI: 1710919501
Provider Name (Legal Business Name): EASTON L. MANDERSON, M.D., F.A.C.S., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 VARNUM ST NE STE 108
WASHINGTON DC
20017-2152
US

IV. Provider business mailing address

1140 VARNUM ST NE STE 108
WASHINGTON DC
20017-2152
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-5300
  • Fax: 202-526-6013
Mailing address:
  • Phone: 202-526-5300
  • Fax: 202-526-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EASTON L. MANDERSON
Title or Position: OWNER
Credential: M.D.
Phone: 202-526-5300