Healthcare Provider Details

I. General information

NPI: 1053522060
Provider Name (Legal Business Name): MARY'S CENTER FOR MATERNAL AND CHILD CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3912 GEORGIA AVE NW
WASHINGTON DC
20011-5861
US

IV. Provider business mailing address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-3000
  • Fax:
Mailing address:
  • Phone: 202-420-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE MARGARETA POWELL-DAVIS
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 202-424-2655