Basic Information
| Provider Information | |||||||||
| NPI: | 1063564458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYERS | ||||||||
| FirstName: | C. EMMANUEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4025 S DAKOTA AVE NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200183253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7733839777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7450 ALBERT RD | ||||||||
| Address2: | |||||||||
| City: | BRANDYWINE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206133035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018882233 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036109654 | IL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208D00000X | 036109654 | IL | N | Allopathic & Osteopathic Physicians | General Practice | 207V00000X | D0070960 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD0349049 | DC | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 4301120119 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | D0070960 | 05 | MD | MEDICAID | 0349049 | 05 | DC | MEDICAID | 036109654 | 05 | IL | MEDICAID | 4301120119 | 05 | MI | MEDICAID |