Provider Demographics
NPI:1497970289
Name:TAVENS, MIRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:TAVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 K ST NW STE 501
Mailing Address - Street 2:GEORGE WASHINGTON UNIVERSITY STUDENT HEALTH SERVICES
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1810
Mailing Address - Country:US
Mailing Address - Phone:202-994-6827
Mailing Address - Fax:202-973-1572
Practice Address - Street 1:2141 K ST NW STE 501
Practice Address - Street 2:GEORGE WASHINGTON UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1810
Practice Address - Country:US
Practice Address - Phone:202-994-6827
Practice Address - Fax:202-973-1572
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine