Healthcare Provider Details

I. General information

NPI: 1194023077
Provider Name (Legal Business Name): IBE MEDICAL ASSOCIATE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE SUITE 106
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE SUITE 106
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-0021
  • Fax: 202-529-5548
Mailing address:
  • Phone: 202-529-0021
  • Fax: 202-529-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD30564
License Number StateDC

VIII. Authorized Official

Name: DR. ANTHONY IKECHUKWU IBE
Title or Position: MD
Credential: MEDICAL DOCTOR
Phone: 202-529-0021