Healthcare Provider Details

I. General information

NPI: 1780618447
Provider Name (Legal Business Name): JUDITH EASTWICK EPSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL MED RESEARCH CTR 503 ROBERT GRANT AVE.
SILVER SPRING MD
20852
US

IV. Provider business mailing address

11108 STILLWATER AVE
KENSINGTON MD
20895-1133
US

V. Phone/Fax

Practice location:
  • Phone: 301-252-9026
  • Fax:
Mailing address:
  • Phone: 301-252-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77508
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: