Healthcare Provider Details

I. General information

NPI: 1750470167
Provider Name (Legal Business Name): GILBERT VEZINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LOUIS GILBERT VEZINA MD

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2978
US

V. Phone/Fax

Practice location:
  • Phone: 202-884-5000
  • Fax:
Mailing address:
  • Phone: 202-884-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD18444
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: