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General NPI Number Information
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NPI Number | 1972099083
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Entity Type | Organization
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Legal Business Name | EMERSON CLINIC
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 508 KENNEDY ST NW STE 207
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City | WASHINGTON
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State | DC
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Zip | 20011
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Country | US
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Telephone | 202-239-0777
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Fax | 202-849-8814
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Provider Business Mailing Address
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Address Line | 508 KENNEDY ST NW STE 306
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City | WASHINGTON
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State | DC
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Zip | 20011-3010
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Country | US
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Telephone | 202-239-0777
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. FABIAN SANDOVAL
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Credential | MD
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Telephone | 202-239-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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