Provider Demographics
NPI:1689783102
Name:GADSDEN, TONJA LOURENE (MD)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:LOURENE
Last Name:GADSDEN
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 1:2024 GEORGIA NWAVE 2ND
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3027
Mailing Address - Country:US
Mailing Address - Phone:202-865-6679
Mailing Address - Fax:202-865-1617
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-3290
Practice Address - Fax:202-865-3833
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD20448207R00000X
MDD0043699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD347231100Medicaid
DC029853700Medicaid
VA010015359Medicaid
MD541791ZDDBMedicare PIN
VA010015359Medicaid
DC029853700Medicaid
MD347231100Medicaid
013227H13Medicare PIN