MEDICARE: TRIPLE TRACK CLINICAL SERVICES

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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1760113278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIPLE TRACK CLINICAL SERVICES

Provider Business Mailing Address
First Line	:	3204 KLINGLE RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3403
Country	:	US
Telephone Number	:	202-215-3565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3204 KLINGLE RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3403
Country	:	US
Telephone Number	:	202-215-3565
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. GEORGE KOLODNER
Credential	:	MD
Telephone Number	:	202-215-3565

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	06/23/2022

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Directions to “TRIPLE TRACK CLINICAL SERVICES ” Practice Location

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