Healthcare Provider Details

I. General information

NPI: 1639168438
Provider Name (Legal Business Name): CHARLES BERUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE, NW CHILDREN'S NATIONAL MEDICAL CENTER
WASHINGTON DC
20010
US

IV. Provider business mailing address

111 MICHIGAN AVE, NW CHILDREN'S NATIONAL MEDICAL CENTER
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5710
  • Fax: 202-476-5700
Mailing address:
  • Phone: 202-476-5710
  • Fax: 202-476-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number79476
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: