Healthcare Provider Details

I. General information

NPI: 1639609910
Provider Name (Legal Business Name): MARVA MONIQUE MOXEY-MIMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARVA MONIQUE MOXEY

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 06/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD45359
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: