| Benning Road Primary Care And Pysician Wieght Loss Pc | |
|
1647 Benning Rd Ne Suite 304 Washington DC 20002-4569 | |
| (202) 397-2200 | |
| (202) 397-2688 |
| Full Name | Benning Road Primary Care And Pysician Wieght Loss Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1647 Benning Rd Ne, Washington, District Of Columbia |
| Authorized Official Name and Position | Ismail Mustapha Kalokoh (CEO) |
| Authorized Official Contact | 2023972200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Benning Road Primary Care And Pysician Wieght Loss Pc 1647 Benning Rd Ne Suite 304 Washington DC 20002-4569 Ph: (202) 397-2200 | Benning Road Primary Care And Pysician Wieght Loss Pc 1647 Benning Rd Ne Suite 304 Washington DC 20002-4569 Ph: (202) 397-2200 |
| NPI Number | 1427388545 |
|---|---|
| Provider Enumeration Date | 01/12/2010 |
| Last Update Date | 01/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427388545 | NPI | - | NPPES |
| 024304300 | Medicaid | MD | |
| 017134100 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD21581 (District Of Columbia) | Primary |
| 207R00000X | Internal Medicine | D0047927 (Maryland) | Secondary |
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