Provider Demographics
NPI:1346433497
Name:LUSE, DAVID MACKENZIE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MACKENZIE
Last Name:LUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 IRVING ST NW
Mailing Address - Street 2:GREEN CLINIC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20422-0001
Mailing Address - Country:US
Mailing Address - Phone:202-745-8596
Mailing Address - Fax:202-518-4880
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:GREEN CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8596
Practice Address - Fax:202-518-4880
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine