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General NPI Number Information
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NPI Number | 1467565192
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Entity Type | Individual
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Provider Name | KRISTINE ADELL DETTLOFF M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 2041 GEORGIA AVE NW STE 1R84
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City | WASHINGTON
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State | DC
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Zip | 20060-4000
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Country | US
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Telephone | 202-865-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 4850 CHEVY CHASE DR
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City | CHEVY CHASE
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State | MD
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Zip | 20815-6420
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Country | US
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Telephone | 301-801-3867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | D7050588
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD037715
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License Number State | DC
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