MEDICARE: PROVIDENCE HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	RN1014643	DC

General Provider Information

NPI Number	:	1134584667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HOSPITAL

Provider Business Mailing Address
First Line	:	1150 VARNUM ST NE
Second Line	:
City	:	WAHINGTON DC
State	:	DC
Zip	:	20017
Country	:	US
Telephone Number	:	202-854-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3413 OLIVE BRANCH DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-4973
Country	:	US
Telephone Number	:	301-256-7630
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	YIESAK ASFAW
Credential	:
Telephone Number	:	301-256-7630

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	12/29/2015

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Directions to “PROVIDENCE HOSPITAL ” Practice Location

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