Healthcare Provider Details

I. General information

NPI: 1154190726
Provider Name (Legal Business Name): WOVENLY IL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 12/25/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 3RD ST NE
WASHINGTON DC
20002-3506
US

IV. Provider business mailing address

912 3RD ST NE
WASHINGTON DC
20002-3506
US

V. Phone/Fax

Practice location:
  • Phone: 571-332-3246
  • Fax:
Mailing address:
  • Phone: 571-332-3246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SACHIN NAGRANI
Title or Position: ORGANIZER
Credential: MD
Phone: 571-332-3246