Healthcare Provider Details

I. General information

NPI: 1518136035
Provider Name (Legal Business Name): EAR,NOSE & THROAT MEDICAL GROUP OF WASHINGTON P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW SUITE 210
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

2021 K ST NW SUITE 210
WASHINGTON DC
20006-1003
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-3560
  • Fax: 202-223-3339
Mailing address:
  • Phone: 202-223-3560
  • Fax: 202-223-3339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD3439
License Number StateDC

VIII. Authorized Official

Name: DR. JAMES GORDON VAP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 202-223-3560