Healthcare Provider Details

I. General information

NPI: 1164404067
Provider Name (Legal Business Name): NATHAN FRANCIS JANUSZ PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

2120 L ST NW STE 450
WASHINGTON DC
20037-1541
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4810
  • Fax: 301-295-6664
Mailing address:
  • Phone: 202-741-2911
  • Fax: 202-741-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA30204
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA30204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: