DR. OPAL E. PETTIS (NPI# 1083798060) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1083798060 |
Entity Type | Individual |
Full Name | DR. OPAL E. PETTIS |
Other Name | OPAL E. THORNTON |
Credential | MD |
Practice Address |
2301 M St Nw Kaiser Permanente Northwest Dc Medical Center Washington DC 20037-1427 |
Mailing Address |
2101 E Jefferson St Kaiser Permanente Medicare Enrollment Rockville MD 20852-4908 |
Practice Telephone | 2024196200 |
Mailing Telephone | 3018162424 |
Enumeration Date | 2006-10-25 |
Last Update Date | 2014-07-29 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
MD042343 | DC | Allopathic & Osteopathic Physicians |
N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
A48065 | CA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CA | 00A480650 | 05 |
Street Address |
2301 M ST NW KAISER PERMANENTE NORTHWEST DC MEDICAL CENTER |
City | WASHINGTON |
State | DC |
Zip Code | 20037-1427 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962865352 | Cassandra Batichon | Family Medicine | 2301 M St Nw, Washington, DC 20037-1427 | 2016-04-01 |
1912371121 | Leah Liszka | Social Worker | 2301 M St Nw, Washington, DC 20037-1427 | 2015-11-26 |
1114260312 | Shuo Chen | Clinic/Center | 2301 M St Nw, Washington, DC 20037-1427 | 2013-04-05 |
1811239122 | Amar Prakash Dave | Internal Medicine | 2301 M St Nw, Washington, DC 20037-1427 | 2013-03-25 |
1720329501 | Justina Nuugwanga N Henok | Pharmacist | 2301 M St Nw, Washington, DC 20037-1427 | 2013-03-05 |
1437490141 | Pamela Denise Waring | Pharmacist | 2301 M St Nw, Washington, DC 20037-1427 | 2013-03-05 |
1679814438 | Avani Patel Arora | Pharmacist | 2301 M St Nw, Pharmacy, Washington, DC 20037-1427 | 2013-03-04 |
1881942555 | Chenere Evans | Counselor | 2301 M St Nw, Washington, DC 20037-1427 | 2012-08-28 |
1841552585 | Ami Norman Levy | Social Worker | 2301 M St Nw, 3rd Floor, Washington, DC 20037-1427 | 2012-06-08 |
1215229885 | Stephanie Staples Hack | Obstetrics & Gynecology | 2301 M St Nw, Department of Obstetrics and Gynecolo, Washington, DC 20037-1427 | 2011-05-13 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033710959 | Wanda H. Rappaport | Psychologist | 2440 M Street, Nw, Suite 512, Washington, DC 20037 | 2020-11-06 |
1477173326 | Lisa Kate Eitches | Student in an Organized Health Care Education/Training Program | The Gw Medical Faculty Associ, 2150 Pennsylvania Ave, Nw, Washington, DC 20037 | 2020-04-21 |
1992280044 | Aakshit Goyal | Student in an Organized Health Care Education/Training Program | The George Washington University Hospital, 900, 23 Rd Street, Washington, DC 20037 | 2018-09-25 |
1649752015 | Jamie Peterson | Counselor | 3 Washington Circle Nw, Suite 406, Washington, DC 20037 | 2018-09-03 |
1003392689 | Eugenie Atallah | Student in an Organized Health Care Education/Training Program | The Gw Medical Faculty Associates 2150 Pennsylvania Ave, 2150 Pennsylvania Avenue, Nw, Washington, DC 20037 | 2018-07-17 |
1033637541 | Brianna Bachelle Eliades | Physical Medicine & Rehabilitation | 2175 K Street, Nw, C120, Washington, DC 20037 | 2017-09-05 |
1376067967 | Candace Mary Willett | Pediatrics | 2440 M St Nw Ste 205, Washington, DC 20037 | 2017-07-26 |
1982125894 | Fransisca Indraswari | Student in an Organized Health Care Education/Training Program | The George Washington Medical Faculty Associates, 2150 Pennsylvania Avenue Nw, Washington, DC 20037 | 2017-06-30 |
1750816021 | Mohammed Alsaggaf | Student in an Organized Health Care Education/Training Program | 900 23rd St Nw, Washington, Dc 20037, Usa, Washington, DC 20037 | 2017-04-25 |
1053868802 | Nicolle Denise Cooley | Speech-Language Pathologist | 2600 Virginia Avenue Nw, Suite #900, Washington, DC 20037 | 2016-09-08 |
Find all providers in zip 20037 |
Taxonomy Code | 2084P0804X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Child & Adolescent Psychiatry |
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
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1689224776 | Quality Care Services, LLC | Psychiatry & Neurology | 1818 New York Ave Ne Ste 222, Washington, DC 20002-1851 | 2019-09-19 |
1124685391 | Howard University | Psychiatry & Neurology | 1001 Monroe St Ne, Washington, DC 20017-1761 | 2019-05-23 |
1073178554 | Howard University | Psychiatry & Neurology | 5600 E Capitol St Ne, Washington, DC 20019-6732 | 2019-05-09 |
1447670443 | Matthew R Salmon | Psychiatry & Neurology | 753 Fairmont St Nw # 1, Washington, DC 20001-3813 | 2014-04-17 |
1881937472 | Kristine Goins | Psychiatry & Neurology | 2115 Wisconsin Ave Nw Ste 200, Washington, DC 20007 | 2013-04-01 |
1932496221 | Alberta M Vallis | Psychiatry & Neurology | 1846 Park Rd Nw, Washington, DC 20010-1019 | 2011-07-07 |
1124275078 | Stewart Leonard Aledort | Psychiatry & Neurology | 1070 Thomas Jefferson St. N.w., Washington, DC 20007 | 2008-08-22 |
1104080696 | Judith L. Rapoport | Psychiatry & Neurology | 3010 44th Pl Nw, Washington, DC 20016-3557 | 2008-07-14 |
1801054374 | Malena Banks | Psychiatry & Neurology | 401 15th St Se Unit 100-c, Washington, DC 20003-3042 | 2008-05-30 |
1326215211 | Susan Katherine Theut | Psychiatry & Neurology | 2114 Huidekoper Pl Nw, Washington, DC 20007-1822 | 2008-05-11 |
Find all providers in WASHINGTON |
City | WASHINGTON |
Zip Code | 20037 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.