Provider Demographics
NPI:1619134731
Name:DEKLOTZ, CYNTHIA MARIE CARVER
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE CARVER
Last Name:DEKLOTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:SUITE 2B 44
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 WISCONSIN AVE NW
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2143
Practice Address - Country:US
Practice Address - Phone:202-295-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042708207NP0225X
MDD0078695207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology