Healthcare Provider Details

I. General information

NPI: 1952561581
Provider Name (Legal Business Name): HEATHER BROSTOWICZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW SUITE W 3600
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW SUITE W 3600
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5448
  • Fax:
Mailing address:
  • Phone: 202-476-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberDO034217
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: