Healthcare Provider Details

I. General information

NPI: 1093773251
Provider Name (Legal Business Name): WASHINGTON PEDIATRIC ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW #708
WASHINGTON DC
20036
US

IV. Provider business mailing address

PO BOX 33879
WASHINGTON DC
20033
US

V. Phone/Fax

Practice location:
  • Phone: 202-955-5625
  • Fax: 202-955-5626
Mailing address:
  • Phone: 202-955-5625
  • Fax: 202-955-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE V LANG
Title or Position: CEO PRESIDENT
Credential:
Phone: 202-955-5625