Healthcare Provider Details

I. General information

NPI: 1033962022
Provider Name (Legal Business Name): ALIYAH RENE BOLTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 04/09/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVENUE NW SUITE 200, DEPT OF PSYCHIATRY
WASHINGTON DC
20007
US

IV. Provider business mailing address

2115 WISCONSIN AVENUE NW SUITE 200, DEPT OF PSYCHIATRY
WASHINGTON DC
20007
US

V. Phone/Fax

Practice location:
  • Phone: 202-944-5400
  • Fax:
Mailing address:
  • Phone: 202-944-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: