For your FREE annual listing, please fill out this form and click the Submit button at the end. Listings received by January 15 will be included in the upcoming print edition of the directory which is published on March 31.   GENERAL INFORMATION Name Medical School   Year of Graduation National Provider Identifier (NPI)     DC License Number MD License Number VA License Number ** License number information is not published           Medical Specialties and Certification Information (Maximum of 4) Primary Specialty   Certified?   2nd Specialty   Certified?   3rd Specialty   Certified?   4th Specialty   Certified?             Foreigh Languages (Maximum of 4) Please list the language(s) in which you are sufficiently fluent to deal with patients on a doctor/patient level or with the assistance of an interpreter. Check if you use an interpreter. Language 1   Language 2 Language 3   Language 4           Hearing Impaired Section I am able to treat patients on a doctor / patient level in Amercan Sign Language Other Sign Language   Phone number for TDD           Group Practice Section I am a full time member of a group practice   Group Practice Name           Address and Phone (Maximum of 4) List a maximum of 4 addresses or 3 addresses and an e-mail. You may list two other phone numbers per address and be certain to indicate what type phone it is. Primary Office Address City   State      Zip   Office Phone       Phone 2   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail Phone 3   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail E-mail Address           Second Office Address City   State      Zip             Office Phone       Phone 2   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail Phone 3   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail           Third Office Address City   State      Zip   Office Phone       Phone 2   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail Phone 3   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail           Fourth Office Address City   State      Zip   Office Phone       Phone 2   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail Phone 3   Phone Type (Select one) Answering Service Beeper or Pager Cell or Car Emergency Fax Metro Physicians Only Residence Toll Free Voice Mail           Request for Additional Information Please send us information on services and advertising opportunities you offer to the medical community.