Healthcare Provider Details

I. General information

NPI: 1528131133
Provider Name (Legal Business Name): ASANTE M DICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

7600 CARROLL AVE RADIOLOGY DEPARTMENT WASHINGTON ADVENTIST HOSPITAL
TAKOMA PARK MD
20912
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 301-891-5650
  • Fax: 301-891-5953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number242636
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD047928
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: