Healthcare Provider Details

I. General information

NPI: 1922527100
Provider Name (Legal Business Name): IMAN NADIYAH MCLAURIN CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

100 ALBANY PL
UPPER MARLBORO MD
20774-1069
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7000
  • Fax:
Mailing address:
  • Phone: 456-167-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: