Healthcare Provider Details

I. General information

NPI: 1396749677
Provider Name (Legal Business Name): DR. FELIPE M DIMAYUGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FELIPE M DIMAYUGA M.D.

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OVERLOOK AVE,SW
WASHINGTON DC
20375-0001
US

IV. Provider business mailing address

5800 GOUCHER DR
BERWYN HEIGHTS MD
20740-2625
US

V. Phone/Fax

Practice location:
  • Phone: 202-767-7300
  • Fax: 202-404-8154
Mailing address:
  • Phone: 202-767-7300
  • Fax: 202-404-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD13874
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: