Healthcare Provider Details

I. General information

NPI: 1366502064
Provider Name (Legal Business Name): CRYSTAL BERNADETTE TAYLOR-DAVIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

1324 GIRARD ST NE
WASHINGTON DC
20017-2448
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-3114
  • Fax: 202-884-3470
Mailing address:
  • Phone: 202-832-4142
  • Fax: 202-529-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD13604
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: