MEDICARE: DR. MARK IRA CINNAMON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	6455	DC

General Provider Information

NPI Number	:	1588699813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK IRA CINNAMON M.D.

Provider Business Mailing Address
First Line	:	2440 M ST NW STE 201
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20037-1449
Country	:	US
Telephone Number	:	202-775-2777
Fax Number	:	202-331-8185

Provider Business Practice Location Address
First Line	:	2440 M ST NW STE 201
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20037-1449
Country	:	US
Telephone Number	:	202-775-2777
Fax Number	:	202-331-8185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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