Healthcare Provider Details

I. General information

NPI: 1053686279
Provider Name (Legal Business Name): ADITYA HALTHORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

10310 MEREDITH AVE
KENSINGTON MD
20895-2945
US

V. Phone/Fax

Practice location:
  • Phone: 202-816-6254
  • Fax:
Mailing address:
  • Phone: 571-643-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD83632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: