Provider Demographics
NPI:1235525700
Name:MUSGROVE, DEREK NATHANIEL (MBBS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:NATHANIEL
Last Name:MUSGROVE
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVE NW
Mailing Address - Street 2:HOWARD UNIVERISTY HOSPITAL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-855-6100
Mailing Address - Fax:
Practice Address - Street 1:701 QUEEN ST
Practice Address - Street 2:
Practice Address - City:SASKATOON
Practice Address - State:SASKATCHEWAN
Practice Address - Zip Code:S7K 0M7
Practice Address - Country:CA
Practice Address - Phone:306-222-5974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ12242207ZF0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program