| |
1160 Varnum St Ne Ste 307 Washington DC 20017-2103 | |
(240) 810-6000 | |
(301) 889-9996 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1160 Varnum St Ne Ste 307, Washington, District Of Columbia |
Authorized Official Name and Position | Kumapley Kofi Lartevi (OWNER) |
Authorized Official Contact | 2408106000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1160 Varnum St Ne Ste 307 Washington DC 20017-2103 Ph: (240) 810-6000 | 1160 Varnum St Ne Ste 307 Washington DC 20017-2103 Ph: (240) 810-6000 |
NPI Number | 1922690619 |
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Provider Enumeration Date | 02/04/2021 |
Last Update Date | 11/26/2024 |
Medicare PECOS PAC ID | 6507272200 |
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Medicare Enrollment ID | O20210303003411 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922690619 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Kumapley Kofi Lartevi |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1902037336 PECOS PAC ID: 1456506377 Enrollment ID: I20131217000267 |
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