Healthcare Provider Details

I. General information

NPI: 1922746155
Provider Name (Legal Business Name): ALYSSA JEANNETTE KANIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW DEPARTMENT OF PSYCHIATRY
WASHINGTON DC
20007
US

IV. Provider business mailing address

3800 RESERVOIR RD NW DEPARTMENT OF PSYCHIATRY
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0116036461
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMTL500001867
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: