Provider Demographics
NPI:1114168341
Name:MEDICAL FACULTY ASSOCIATES
Entity Type:Organization
Organization Name:MEDICAL FACULTY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TATELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-741-3375
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:SUITE 10-407
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-3375
Mailing Address - Fax:202-741-3396
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:SUITE 10-407
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-3375
Practice Address - Fax:202-741-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1672103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty