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General NPI Number Information
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NPI Number | 1710919501
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Entity Type | Organization
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Legal Business Name | EASTON L. MANDERSON, M.D., F.A.C.S., PC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 1140 VARNUM ST NE STE 108
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City | WASHINGTON
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State | DC
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Zip | 20017-2152
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Country | US
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Telephone | 202-526-5300
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Fax | 202-526-6013
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Provider Business Mailing Address
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Address Line | 1140 VARNUM ST NE STE 108
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City | WASHINGTON
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State | DC
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Zip | 20017-2152
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Country | US
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Telephone | 202-526-5300
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Fax | 202-526-6013
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Authorized Official
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Title or Position | OWNER
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Name | DR. EASTON L. MANDERSON
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Credential | M.D.
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Telephone | 202-526-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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