Healthcare Provider Details

I. General information

NPI: 1891498325
Provider Name (Legal Business Name): ALPHONSO PONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 4TH ST NE
WASHINGTON DC
20002-1211
US

IV. Provider business mailing address

1949 4TH ST NE
WASHINGTON DC
20002-1211
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-7500
  • Fax: 202-462-2309
Mailing address:
  • Phone: 202-462-7500
  • Fax: 202-462-2309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: