Provider Demographics
NPI:1053514125
Name:DOSOVITZ, IRA (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:DOSOVITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 29TH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2108
Mailing Address - Country:US
Mailing Address - Phone:202-362-7757
Mailing Address - Fax:202-537-9156
Practice Address - Street 1:4705 29TH PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2108
Practice Address - Country:US
Practice Address - Phone:202-362-7757
Practice Address - Fax:202-537-9156
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD112602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry