DR. OPAL E. PETTIS


Address: 2301 M St Nw, Kaiser Permanente Northwest Dc Medical Center, Washington, DC 20037-1427
Phone: 2024196200

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
CA 00A480650 05

Office Location

Street Address 2301 M ST NW
KAISER PERMANENTE NORTHWEST DC MEDICAL CENTER
City WASHINGTON
State DC
Zip Code 20037-1427

Providers in the same location

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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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 2084P0804X
Grouping Allopathic & Osteopathic Physicians
Classification Psychiatry & Neurology
Specialization Child & Adolescent Psychiatry

Taxonomy Definition

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]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
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
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Competitor

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City WASHINGTON
Zip Code 20037

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Dataset Information

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.

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