Healthcare Provider Details

I. General information

NPI: 1518878206
Provider Name (Legal Business Name): ANACOSTIA CRITICAL CARE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PECAN ST SE
WASHINGTON DC
20032-2652
US

IV. Provider business mailing address

8904 GARDEN GATE DR
FAIRFAX VA
22031-1471
US

V. Phone/Fax

Practice location:
  • Phone: 771-444-6200
  • Fax:
Mailing address:
  • Phone: 202-247-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MINA M YACOUB
Title or Position: PRESIDENT
Credential: MD
Phone: 202-247-1218