Healthcare Provider Details

I. General information

NPI: 1821606443
Provider Name (Legal Business Name): THERESA R WATKINS-BRYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOWARD UNIV HOSPITAL 2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

1507 DANWOOD LN
MITCHELLVILLE MD
20721-3231
US

V. Phone/Fax

Practice location:
  • Phone: 301-775-0206
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12667
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: