Healthcare Provider Details

I. General information

NPI: 1427464585
Provider Name (Legal Business Name): ALICE BUDIMAN EGGLESTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 14TH ST NW
WASHINGTON DC
20009-4308
US

IV. Provider business mailing address

1701 14TH ST NW
WASHINGTON DC
20009-4308
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-6113
  • Fax: 202-745-6152
Mailing address:
  • Phone: 202-745-6113
  • Fax: 202-745-6152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031062
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: