Provider Demographics
NPI:1275635559
Name:PABLO-BUSTOS, DORIS V (MD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:V
Last Name:PABLO-BUSTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:
Other - Last Name:PABLO-BUSTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:1140 VARNUM ST NE PMB 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2151
Mailing Address - Country:US
Mailing Address - Phone:202-269-6430
Mailing Address - Fax:202-269-6598
Practice Address - Street 1:1140 VARNUM ST NE PMB 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-269-6430
Practice Address - Fax:202-269-6598
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056019261QP2300X, 302F00000X, 302R00000X, 305R00000X, 305S00000X
DCMD30307261QP2300X, 302F00000X, 302R00000X, 305R00000X, 305S00000X, 207R00000X
MDD0058776302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC033872900Medicaid
DC050883700Medicaid
VAF811-0001OtherCAREFIRST BCBS
MD510223500Medicaid
DC033872900Medicaid
DC030402916OtherCIGNA
VA030402916OtherCIGNA
DC030402916OtherUNITED HEALTH CARE
DC030402916OtherGREAT WEST
DC030402916OtherANTHEM BCBS
DCF811-0001OtherCAREFIRST BCBS
DC030402916OtherAETNA
VA030402916OtherTRICARE
VAF811-0001OtherCAREFIRST BCBS
DC00B155D61OtherMEDICARE
VA030402916OtherAETNA
DC030402916OtherGEHA
VA030402916OtherANTHEM BCBS
DC030402916OtherTRICARE
MD510223500Medicaid
DC030402816OtherMAILHANDLERS
DC030402916OtherGEHA