Healthcare Provider Details

I. General information

NPI: 1518147735
Provider Name (Legal Business Name): JAMES FLAHERTY AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2149
US

IV. Provider business mailing address

1150 VARNUM ST NE
WASHINGTON DC
20017-2149
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-7000
  • Fax: 202-269-7825
Mailing address:
  • Phone: 202-269-7000
  • Fax: 202-269-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA000011
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: