Basic Information
| Provider Information | |||||||||
| NPI: | 1710327655 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALZIEL | ||||||||
| FirstName: | PEREGRINE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4650 WASHINGTON BLVD | ||||||||
| Address2: | APT 325 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222015737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177589405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2150 PENNSYLVANIA AVE NW | ||||||||
| Address2: | GW MEDICAL FACULTY ASSOCIATES | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200373201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2027413000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2013 | ||||||||
| LastUpdateDate: | 06/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MTL001605 | DC | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.