Healthcare Provider Details

I. General information

NPI: 1205077781
Provider Name (Legal Business Name): KEITH ROBERT UNGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3817 DAVIS PLACE NW APT 2
WASHINGTON DC
20007
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD037664
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: