Active NPI
Makon Fardis, PHD
- Clinical Psychologist
- Washington, DC
National Provider Identifier
1760781512
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 1000573
- Practice address
- 2029 P St NW
Suite 302
Washington, DC 20036-5948 - Phone
- (202) 906-9614
- NPI assigned
- Mar 18, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 1000573 | DC | Primary |
Addresses
Primary practice location
2029 P St NW
Suite 302
Washington, DC 20036-5948
Mailing address
4743 Bradley Blvd
# 302
Chevy Chase, MD 20815-6303
Phone (406) 531-5664
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 15, 2015 through May 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 1000573 | DC | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300406400000",
"number": "1760781512",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4743 BRADLEY BLVD",
"address_2": "# 302",
"city": "CHEVY CHASE",
"state": "MD",
"postal_code": "208156303",
"telephone_number": "406-531-5664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2029 P ST NW",
"address_2": "SUITE 302",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200365948",
"telephone_number": "202-906-9614"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARDIS",
"first_name": "MAKON",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-18",
"last_updated": "2011-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "DC",
"license": "PSY 1000573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.