Healthcare Provider Details

I. General information

NPI: 1790776961
Provider Name (Legal Business Name): IEON LLOYD DAWSON M.D.,F.A.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 OLD BRANCH AVE SUITE B 205
CLINTON MD
20735-1628
US

IV. Provider business mailing address

PO BOX 3786
CROFTON MD
21114-3786
US

V. Phone/Fax

Practice location:
  • Phone: 301-877-4933
  • Fax: 301-877-6963
Mailing address:
  • Phone: 301-877-4933
  • Fax: 301-877-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0047553
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: