Healthcare Provider Details

I. General information

NPI: 1417571530
Provider Name (Legal Business Name): ONE MEDSTAR PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 G ST NW STE 200 EAST
WASHINGTON DC
20001-4545
US

IV. Provider business mailing address

PO BOX 412829
BOSTON MA
02241-2829
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-0005
  • Fax: 202-660-0025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SCHNEIDER
Title or Position: VP
Credential:
Phone: 703-558-1403