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General NPI Number Information
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NPI Number | 1558394221
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Entity Type | Organization
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Legal Business Name | MARY C DUPONT MD PC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 5530 WISCONSIN AVE STE 1510
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4404
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Country | US
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Telephone | 301-654-5530
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Fax | 301-654-5540
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Provider Business Mailing Address
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Address Line | 5530 WISCONSIN AVE STE 1510
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City | CHEVY CHASE
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State | MD
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Zip | 20815-4404
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Country | US
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Telephone | 301-654-5530
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Fax | 301-654-5540
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. JOHN ROBERT DUPONT
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Credential | J.D.
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Telephone | 301-654-5530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0052162
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License Number State | MD
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