=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124600887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON INSTITUTE OF DERMATOLOGIC LASER SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2021
-----------------------------------------------------
Last Update Date | 04/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1430 K ST NW STE 200
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20005-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-628-8855
-----------------------------------------------------
Fax | 202-628-8850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1430 K ST NW STE 200
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20005-2554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-628-8855
-----------------------------------------------------
Fax | 202-628-8850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TINA ALSTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 334-332-2444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------