Provider Demographics
NPI:1821181223
Name:LABISSIERE, BERTHIE MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BERTHIE
Middle Name:MARIE
Last Name:LABISSIERE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7603 GEORGIA AVE NW
Mailing Address - Street 2:STE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1630
Mailing Address - Country:US
Mailing Address - Phone:202-882-9682
Mailing Address - Fax:202-882-4983
Practice Address - Street 1:7603 GEORGIA AVE NW
Practice Address - Street 2:STE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1630
Practice Address - Country:US
Practice Address - Phone:202-882-9682
Practice Address - Fax:202-882-4983
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC017138200Medicaid
DCU71039Medicare UPIN
DC017138200Medicaid
DC000M13M87Medicare PIN