Healthcare Provider Details

I. General information

NPI: 1215505409
Provider Name (Legal Business Name): PAULA GOMES TOLEDO BARROS COSTANTINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ALABAMA AVE SE STE 238
WASHINGTON DC
20032-4542
US

IV. Provider business mailing address

1100 ALABAMA AVE SE STE 238
WASHINGTON DC
20032-4542
US

V. Phone/Fax

Practice location:
  • Phone: 202-299-5334
  • Fax: 202-561-6953
Mailing address:
  • Phone: 202-299-5334
  • Fax: 202-561-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number400001208
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: