Healthcare Provider Details

I. General information

NPI: 1184804015
Provider Name (Legal Business Name): DANIEL SAMUEL PINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVENUE NW SUITE 400 THE ROSS CENTER
WASHINGTON DC
20015
US

IV. Provider business mailing address

5225 WISCONSIN AVENUE NW SUITE 400 THE ROSS CENTER
WASHINGTON DC
20015
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-1010
  • Fax: 202-363-2383
Mailing address:
  • Phone: 202-363-1010
  • Fax: 202-363-2383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD33300
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD33300
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: