1083626451 NPI number — WASHINGTON GASTROENTEROLOGY, PC

Table of content: (NPI 1083626451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083626451 NPI number — WASHINGTON GASTROENTEROLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON GASTROENTEROLOGY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083626451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20813-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-829-0022
Provider Business Mailing Address Fax Number:
202-829-2927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 IRVING ST NW
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-829-0170
Provider Business Practice Location Address Fax Number:
202-829-2927
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LAMB
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
BOOKKEEPER
Authorized Official Telephone Number:
202-829-0022

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C30973 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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