Healthcare Provider Details

I. General information

NPI: 1407130362
Provider Name (Legal Business Name): BRIGITTE C WIDEMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 BRADMOOR DR
BETHESDA MD
20817-3457
US

IV. Provider business mailing address

8906 BRADMOOR DRIVE
BETHESDA MD
20817-3457
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-7387
  • Fax: 301-480-8871
Mailing address:
  • Phone: 301-496-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberD0054838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: