Healthcare Provider Details

I. General information

NPI: 1861563983
Provider Name (Legal Business Name): LAURA MCWADE PAEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-5000
  • Fax:
Mailing address:
  • Phone: 202-476-2057
  • Fax: 202-476-4156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberRN54427
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: