Healthcare Provider Details

I. General information

NPI: 1780670281
Provider Name (Legal Business Name): BRETT D COONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/31/2026
Certification Date: 12/30/2019
Deactivation Date: 08/09/2026
Reactivation Date: 08/31/2026

III. Provider practice location address

1050 W PERIMETER RD
JB ANDREWS MD
20762-6601
US

IV. Provider business mailing address

1050 W PERIMETER RD
JB ANDREWS MD
20762-6601
US

V. Phone/Fax

Practice location:
  • Phone: 240-612-1582
  • Fax:
Mailing address:
  • Phone: 240-612-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number01058214A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01058214A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: