Provider Demographics
NPI:1295147015
Name:SENISI, BRYAN MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MATTHEW
Last Name:SENISI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 NEW HAMPSHIRE AVE NW STE 121
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6313
Mailing Address - Country:US
Mailing Address - Phone:202-463-0220
Mailing Address - Fax:202-463-0222
Practice Address - Street 1:1330 NEW HAMPSHIRE AVE NW STE 121
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6313
Practice Address - Country:US
Practice Address - Phone:202-463-0220
Practice Address - Fax:202-463-0222
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC390200000X
DCDO034779207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCDO034779OtherDC MEDICAL LICENSE