Healthcare Provider Details

I. General information

NPI: 1235265950
Provider Name (Legal Business Name): TRISTAN L. GORRINDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date: 10/03/2022
Reactivation Date: 10/11/2022

III. Provider practice location address

5225 WISCONSIN AVE NW
WASHINGTON DC
20015-2014
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW STE 400
WASHINGTON DC
20015-2055
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD045560
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD045560
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: