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1160 Varnum St Ne Depaul 317 Washington DC 20017-2107 | |
| (202) 640-4837 | |
| (202) 636-1138 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1160 Varnum St Ne, Washington, District Of Columbia |
| Authorized Official Name and Position | Beau Higginbotham (VICE PRESIDENT/COO) |
| Authorized Official Contact | 4103683162 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 Ph: (202) 854-4069 | 1160 Varnum St Ne Depaul 317 Washington DC 20017-2107 Ph: (202) 640-4837 |
| NPI Number | 1043474497 |
|---|---|
| Provider Enumeration Date | 07/15/2008 |
| Last Update Date | 10/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043474497 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | HFD01-0212 (District Of Columbia) | Primary |
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