Basic Information
| Provider Information | |||||||||
| NPI: | 1689783102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GADSDEN | ||||||||
| FirstName: | TONJA | ||||||||
| MiddleName: | LOURENE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2024 GEORGIA NWAVE 2ND | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200013027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028656679 | ||||||||
| FaxNumber: | 2028651617 | ||||||||
| Practice Location | |||||||||
| Address1: | 2041 GEORGIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028653290 | ||||||||
| FaxNumber: | 2028653833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD20448 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D0043699 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 347231100 | 05 | MD | MEDICAID | 029853700 | 05 | DC | MEDICAID | 010015359 | 05 | VA | MEDICAID |