Provider Demographics
NPI:1558574525
Name:ANTHRACITE, NANCY ETHEL (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ETHEL
Last Name:ANTHRACITE
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:VETERANS AFFAIRS HEALTH UNIT 032A1
Mailing Address - Street 2:810 VERMONT AVENUE NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20420-0001
Mailing Address - Country:US
Mailing Address - Phone:202-461-5056
Mailing Address - Fax:
Practice Address - Street 1:VETERANS AFFAIRS HEALTH UNIT 032A1
Practice Address - Street 2:810 VERMONT AVENUE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20420-0001
Practice Address - Country:US
Practice Address - Phone:202-461-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B92705Medicare UPIN