| |
6323 Georgia Ave Nw Ste 104 Washington DC 20011-1137 | |
(202) 683-0268 | |
(202) 723-4494 |
Full Name | |
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Speciality | General Practice |
Location | 6323 Georgia Ave Nw Ste 104, Washington, District Of Columbia |
Authorized Official Name and Position | Eric A Tchuigoua (FOUNDER & CEO) |
Authorized Official Contact | 2026830268 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6323 Georgia Ave Nw Ste 104 Washington DC 20011-1137 Ph: (202) 683-0268 | 6323 Georgia Ave Nw Ste 104 Washington DC 20011-1137 Ph: (202) 683-0268 |
NPI Number | 1407590862 |
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Provider Enumeration Date | 04/22/2022 |
Last Update Date | 08/09/2022 |
Medicare PECOS PAC ID | 6709264591 |
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Medicare Enrollment ID | O20220607002491 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407590862 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
Provider Name | Laure B Ndeutchoua |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1013302728 PECOS PAC ID: 1557657194 Enrollment ID: I20160908001702 |
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