Healthcare Provider Details

I. General information

NPI: 1740201763
Provider Name (Legal Business Name): ALICE GUTKNECHT FARLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 14TH ST NW
WASHINGTON DC
20009-6865
US

IV. Provider business mailing address

1324 E ST SE UNIT 312
WASHINGTON DC
20003-3983
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-4300
  • Fax:
Mailing address:
  • Phone: 504-858-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD045889
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: