Provider Demographics
NPI:1376606624
Name:BRODY, DAN TALIAFERRO (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:TALIAFERRO
Last Name:BRODY
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 1:2021 K ST NW STE 400
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1009
Mailing Address - Country:US
Mailing Address - Phone:202-833-3500
Mailing Address - Fax:202-833-3503
Practice Address - Street 1:2021 K ST NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1009
Practice Address - Country:US
Practice Address - Phone:202-833-3500
Practice Address - Fax:202-833-3503
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30725207RA0201X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H56912Medicare UPIN