Healthcare Provider Details

I. General information

NPI: 1760455307
Provider Name (Legal Business Name): ROBERT E. DEMARTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CENTER 6900 GEORGIA AVE.
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

2801 QUEBEC ST NW APT. 724
WASHINGTON DC
20008-1227
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-3501
  • Fax:
Mailing address:
  • Phone: 202-237-9052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number58668
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: