Healthcare Provider Details

I. General information

NPI: 1972757680
Provider Name (Legal Business Name): PHILIP ATAJUH AKWAR R.N
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 13TH PL NE
WASHINGTON DC
20017-3106
US

IV. Provider business mailing address

4717 13TH PL NE
WASHINGTON DC
20017-3106
US

V. Phone/Fax

Practice location:
  • Phone: 240-501-6161
  • Fax:
Mailing address:
  • Phone: 240-501-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN59861
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: