Healthcare Provider Details

I. General information

NPI: 1295147015
Provider Name (Legal Business Name): BRYAN MATTHEW SENISI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 NEW HAMPSHIRE AVE NW STE 121
WASHINGTON DC
20036-6313
US

IV. Provider business mailing address

1330 NEW HAMPSHIRE AVE NW STE 121
WASHINGTON DC
20036-6313
US

V. Phone/Fax

Practice location:
  • Phone: 202-463-0220
  • Fax: 202-463-0222
Mailing address:
  • Phone: 202-463-0220
  • Fax: 202-463-0222

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 StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO034779
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: