Healthcare Provider Details

I. General information

NPI: 1417691726
Provider Name (Legal Business Name): JOHN PREMPEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0002
US

IV. Provider business mailing address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0002
US

V. Phone/Fax

Practice location:
  • Phone: 405-761-4989
  • Fax:
Mailing address:
  • Phone: 405-761-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101289702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: