Healthcare Provider Details

I. General information

NPI: 1104926609
Provider Name (Legal Business Name): CAROL ANN DYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 ALBEMARLE ST NW
WASHINGTON DC
20008-1037
US

IV. Provider business mailing address

2825 ALBEMARLE ST NW
WASHINGTON DC
20008-1037
US

V. Phone/Fax

Practice location:
  • Phone: 202-362-1261
  • Fax:
Mailing address:
  • Phone: 202-362-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD15538
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: