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General NPI Number Information
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NPI Number | 1639669575
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Entity Type | Individual
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Provider Name | BEVERLI FONTAINE-RASAIAH MD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 5550 FRIENDSHIP BLVD STE 360
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City | CHEVY CHASE
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State | MD
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Zip | 20815-7256
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Country | US
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Telephone | 240-341-1290
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 GREENSBORO DR STE L1-121
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City | MC LEAN
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State | VA
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Zip | 22102-3605
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Country | US
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Telephone | 702-223-4072
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | D0085002
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License Number State | MD
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