Healthcare Provider Details

I. General information

NPI: 1013354455
Provider Name (Legal Business Name): DAWN CANNON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 402
WASHINGTON DC
20015-2055
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW STE 402
WASHINGTON DC
20015-2055
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number043565
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: