MEDICARE: THE GRADFORD GROUP (USA), INC

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	208D00000X	General Practice Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1184067647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GRADFORD GROUP (USA), INC

Provider Business Mailing Address
First Line	:	1250 CONNECTICUT AVE NW
Second Line	:	SUITE 200
City	:	WASHINGTON
State	:	DC
Zip	:	20036-2603
Country	:	US
Telephone Number	:	202-386-6789
Fax Number	:	202-240-5221

Provider Business Practice Location Address
First Line	:	1250 CONNECTICUT AVE NW
Second Line	:	SUITE 200
City	:	WASHINGTON
State	:	DC
Zip	:	20036-2603
Country	:	US
Telephone Number	:	202-386-6789
Fax Number	:	202-240-5221

Authorized Official
Title or Position	:	PRESIDENT & FOUNDER
Name	:	DR. CHRISTOPHER KAINGO
Credential	:	M.D
Telephone Number	:	202-386-6789

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	04/15/2013

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