Provider Demographics
NPI:1720246291
Name:KRUSE, STACY REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:REBECCA
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:REBECCA
Other - Last Name:HOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3800 RESERVOIR RD NW # G3041
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-3976
Mailing Address - Fax:202-444-5104
Practice Address - Street 1:3800 RESERVOIR RD NW # G3041
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3976
Practice Address - Fax:202-444-5104
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD044966207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine