Healthcare Provider Details

I. General information

NPI: 1538426051
Provider Name (Legal Business Name): FRANK S. ASHBURN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 21
WASHINGTON DC
20016
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW STE 21
WASHINGTON DC
20016-4360
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-6700
  • Fax: 202-686-0925
Mailing address:
  • Phone: 202-686-6700
  • Fax: 202-686-0925

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 Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD046465
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101262585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: