Healthcare Provider Details

I. General information

NPI: 1104351030
Provider Name (Legal Business Name): MISTY EMBREY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 NEW HAMPSHIRE AVE NW STE 200
WASHINGTON DC
20037-2334
US

IV. Provider business mailing address

908 NEW HAMPSHIRE AVE NW STE 200
WASHINGTON DC
20037-2334
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-5055
  • Fax:
Mailing address:
  • Phone: 202-833-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0091159
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101273955
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70338
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number70338-20
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD210001481
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: