Healthcare Provider Details

I. General information

NPI: 1740550201
Provider Name (Legal Business Name): OPTIMAL PREVENTIVE MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 F STREET, NW SUITE 501
WASHINGTON DC
20037
US

IV. Provider business mailing address

2112 F STREET, NW SUITE 501
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 202-296-1438
  • Fax: 202-296-1549
Mailing address:
  • Phone: 202-296-1438
  • Fax: 202-296-1549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD304445
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD304445
License Number StateDC

VIII. Authorized Official

Name: DR. SYLVIA RENEE MEDLEY
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D., M.P.H
Phone: 202-296-1438