Provider Demographics
NPI:1205260700
Name:KONRAD L DAWSON, MD, PC
Entity type:Organization
Organization Name:KONRAD L DAWSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KONRAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-726-1000
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:#2400N
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-726-1000
Mailing Address - Fax:202-726-1601
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:#2400N
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-726-1000
Practice Address - Fax:202-726-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25996208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD527301300Medicaid
DC025425300Medicaid
DC025425300Medicaid
MD527301300Medicaid