Healthcare Provider Details

I. General information

NPI: 1255416780
Provider Name (Legal Business Name): ALAN E SIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW GENERAL PEDIATRICS (C/O SHANAZ MIRZA)--SUITE 2110
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

10615 MARGATE RD
SILVER SPRING MD
20901-1655
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-3948
  • Fax:
Mailing address:
  • Phone: 301-592-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD034768
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD63482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: