Healthcare Provider Details

I. General information

NPI: 1164567475
Provider Name (Legal Business Name): DENNIS R WIRT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PENNSYLVANIA AVE SE #310
WASHINGTON DC
20003
US

IV. Provider business mailing address

801 PENNSYLVANIA AVE SE #310
WASHINGTON DC
20003
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-3100
  • Fax: 202-547-0722
Mailing address:
  • Phone: 202-547-3100
  • Fax: 202-547-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12713
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: