Healthcare Provider Details

I. General information

NPI: 1881985778
Provider Name (Legal Business Name): DR. DYANN WAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BRENTWOOD RD NE
WASHINGTON DC
20066-9998
US

IV. Provider business mailing address

4004 KENNEDY ST
HYATTSVILLE MD
20781-1735
US

V. Phone/Fax

Practice location:
  • Phone: 202-636-1434
  • Fax: 202-636-2024
Mailing address:
  • Phone: 301-699-0867
  • Fax: 301-699-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberD0027312
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: