| Providence Hospital | |
|
1160 Varnum St Ne Washington DC 20017-2107 | |
| (202) 854-7000 | |
| (202) 269-7160 |
| Full Name | Providence Hospital |
|---|---|
| Speciality | Family Medicine |
| Location | 1160 Varnum St Ne, Washington, District Of Columbia |
| Authorized Official Name and Position | Mitchell Lomax (VICE PRESIDENT/CFO) |
| Authorized Official Contact | 6672342926 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Hospital 1150 Varnum St Ne Administration 4th Floor Washington DC 20017-2149 Ph: (202) 854-4255 | Providence Hospital 1160 Varnum St Ne Washington DC 20017-2107 Ph: (202) 854-7000 |
| NPI Number | 1669453809 |
|---|---|
| Provider Enumeration Date | 11/06/2005 |
| Last Update Date | 11/01/2023 |
| Certification Date | 11/01/2023 |
| Medicare PECOS PAC ID | 4385541622 |
|---|---|
| Medicare Enrollment ID | O20031216000187 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669453809 | NPI | - | NPPES |
| 023435102 | Medicaid | DC | |
| 023435100 | Medicaid | DC | |
| 080352200 | Medicaid | DC | |
| 5485215 00 | Medicaid | DC | |
| 023435101 | Medicaid | MD | |
| 5485215 01 | Medicaid | MD |
| Provider Name | Nancy G Shaffer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679500896 PECOS PAC ID: 7618874835 Enrollment ID: I20031216000747 |
| Provider Name | Bindu C Joseph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518993559 PECOS PAC ID: 4688560832 Enrollment ID: I20040224001258 |
| Provider Name | Cecillia Tsao |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821101767 PECOS PAC ID: 6406848811 Enrollment ID: I20040402000862 |
| Provider Name | Josephine M Weeks |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407823826 PECOS PAC ID: 2264423276 Enrollment ID: I20040519000953 |
| Provider Name | Shiban L Raina |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861422669 PECOS PAC ID: 5193708519 Enrollment ID: I20040608000819 |
| Provider Name | David R King |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992746127 PECOS PAC ID: 7618929407 Enrollment ID: I20050221000485 |
| Provider Name | Abbott Huang |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144204371 PECOS PAC ID: 4486545886 Enrollment ID: I20050624000846 |
| Provider Name | Shadi Soufi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326250705 PECOS PAC ID: 5991895203 Enrollment ID: I20071226000069 |
| Provider Name | Asim Haracic |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821025834 PECOS PAC ID: 1759445232 Enrollment ID: I20090128000213 |
| Provider Name | Syed M Ali |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1477686806 PECOS PAC ID: 9032262621 Enrollment ID: I20090908000402 |
| Provider Name | Rafic K Jarrah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073523759 PECOS PAC ID: 2567517931 Enrollment ID: I20090909000017 |
| Provider Name | Homaira Ahad-amiri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740298553 PECOS PAC ID: 1153459805 Enrollment ID: I20100517000768 |
| Provider Name | Mir Javid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992004030 PECOS PAC ID: 6709061096 Enrollment ID: I20110502000479 |
| Provider Name | Namman N Halabi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023047727 PECOS PAC ID: 5597942870 Enrollment ID: I20110614000614 |
| Provider Name | William J Strudwick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1407886815 PECOS PAC ID: 8527233253 Enrollment ID: I20111208000410 |
| Provider Name | Kimberly Bullock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992734685 PECOS PAC ID: 7810162377 Enrollment ID: I20111212000293 |
| Provider Name | Marcy Oppenheimer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023243581 PECOS PAC ID: 6305094327 Enrollment ID: I20120918000096 |
| Provider Name | Uchenna Obichere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013200484 PECOS PAC ID: 0941451207 Enrollment ID: I20121114000092 |
| Provider Name | Jacquelyn M Horton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295080240 PECOS PAC ID: 9638320955 Enrollment ID: I20121115000067 |
| Provider Name | Ines Natividad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548557747 PECOS PAC ID: 4082858188 Enrollment ID: I20130911000208 |
| Provider Name | Melat Assefa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508297805 PECOS PAC ID: 2567694144 Enrollment ID: I20140414000966 |
| Provider Name | Melissa Fagonde |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164715926 PECOS PAC ID: 2567683949 Enrollment ID: I20141028002724 |
| Provider Name | Ajirioghene Igbide |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659610871 PECOS PAC ID: 8123249331 Enrollment ID: I20141031000075 |
| Provider Name | Marc Stephen Cottrell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1609945500 PECOS PAC ID: 7315262649 Enrollment ID: I20150209001650 |
| Provider Name | Josephine Nwachukwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073860466 PECOS PAC ID: 6002057403 Enrollment ID: I20151112001566 |
| Provider Name | Victoria Fedorova |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1306100185 PECOS PAC ID: 4183911001 Enrollment ID: I20160921000420 |
| Provider Name | Theresa Claire Brady Novak |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194982249 PECOS PAC ID: 1759664436 Enrollment ID: I20170202001651 |
| Provider Name | Deborah V Suchman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972055457 PECOS PAC ID: 3678856069 Enrollment ID: I20170209000449 |
| Provider Name | Daniel O Omire-mayor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831504505 PECOS PAC ID: 0345543799 Enrollment ID: I20171013000139 |
| Provider Name | Fatmata K Ware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285121954 PECOS PAC ID: 2769723071 Enrollment ID: I20190416000154 |
| Provider Name | Jane O Ighalo-edoro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215595350 PECOS PAC ID: 6002148384 Enrollment ID: I20191106001900 |
| Provider Name | Pamela Fru Tange Oriaifo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508406653 PECOS PAC ID: 9830527407 Enrollment ID: I20200313000021 |
| Provider Name | Elmer Amparo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912499708 PECOS PAC ID: 0143570689 Enrollment ID: I20200921000435 |
| Provider Name | Saleem Farooqui |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518169879 PECOS PAC ID: 4789756446 Enrollment ID: I20201029001063 |
| Provider Name | Syed Hamid Husain |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1831167261 PECOS PAC ID: 8224079611 Enrollment ID: I20201102001435 |
| Provider Name | Mohammad Naseem |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1336139310 PECOS PAC ID: 6305887571 Enrollment ID: I20210208001132 |
| Provider Name | Asgar Saleem |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1699855130 PECOS PAC ID: 9133224371 Enrollment ID: I20210217001064 |
| Provider Name | Agnes Hlompho Moneri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760088108 PECOS PAC ID: 0042695504 Enrollment ID: I20220920000351 |
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