| Ennoble Hc Dmv Llc | |
|
962 Wayne Ave Ste 250 Silver Spring MD 20910-4433 | |
| (862) 812-9010 | |
| Not Available |
| Full Name | Ennoble Hc Dmv Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 962 Wayne Ave Ste 250, Silver Spring, Maryland |
| Authorized Official Name and Position | Kush Das (MANAGER) |
| Authorized Official Contact | 3107212971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ennoble Hc Dmv Llc 39 V St Ne Washington DC 20002-1329 Ph: (862) 812-9010 | Ennoble Hc Dmv Llc 962 Wayne Ave Ste 250 Silver Spring MD 20910-4433 Ph: (862) 812-9010 |
| NPI Number | 1104492115 |
|---|---|
| Provider Enumeration Date | 06/01/2021 |
| Last Update Date | 11/08/2022 |
| Medicare PECOS PAC ID | 9032517925 |
|---|---|
| Medicare Enrollment ID | O20211007000017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104492115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Johnnilyn Kutten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417110933 PECOS PAC ID: 0749348332 Enrollment ID: I20081027000351 |
| Provider Name | James R Eskew |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1114915592 PECOS PAC ID: 6406988484 Enrollment ID: I20100712000235 |
| Provider Name | Summit Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942485321 PECOS PAC ID: 6406931674 Enrollment ID: I20110107000257 |
| Provider Name | Danielle E Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831478890 PECOS PAC ID: 0941468979 Enrollment ID: I20120222000812 |
| Provider Name | Amanda Carmel Goldfarb |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1598926461 PECOS PAC ID: 7113172115 Enrollment ID: I20140716000032 |
| Provider Name | Patricia Chang Carpenter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730505546 PECOS PAC ID: 5799903738 Enrollment ID: I20170227000200 |
| Provider Name | Adediwura Ajadi Jolaoso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801312053 PECOS PAC ID: 6305106022 Enrollment ID: I20180129000229 |
| Provider Name | Touko Barthelemy Leuga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174132682 PECOS PAC ID: 0547678526 Enrollment ID: I20210517000469 |
| Provider Name | Ivan H Racadag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083062392 PECOS PAC ID: 0648568121 Enrollment ID: I20220606002978 |
| Provider Name | Lori Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154891000 PECOS PAC ID: 0446599526 Enrollment ID: I20230216001105 |
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