Healthcare Provider Details

I. General information

NPI: 1871864421
Provider Name (Legal Business Name): OLIVIA EASLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 OLD GEORGETOWN RD
BETHESDA MD
20814-1620
US

IV. Provider business mailing address

9309 OLD GEORGETOWN RD
BETHESDA MD
20814-1620
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0058385
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: