Healthcare Provider Details

I. General information

NPI: 1134864440
Provider Name (Legal Business Name): DESTINY LOUANNIAH MORRISON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLD WASHINGTON RD STE 100
WALDORF MD
20602-3249
US

IV. Provider business mailing address

3450 OLD WASHINGTON RD STE 100
WALDORF MD
20602-3249
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-0300
  • Fax:
Mailing address:
  • Phone: 301-645-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0103665
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: