Healthcare Provider Details

I. General information

NPI: 1043517154
Provider Name (Legal Business Name): CHILDRENS MEDICAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 14TH ST NW
WASHINGTON DC
20011-3613
US

IV. Provider business mailing address

5425 14TH ST NW
WASHINGTON DC
20011-3613
US

V. Phone/Fax

Practice location:
  • Phone: 202-829-7700
  • Fax:
Mailing address:
  • Phone: 202-829-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD15318
License Number StateDC

VIII. Authorized Official

Name: MRS. DANA SADDLER
Title or Position: ADMIN
Credential:
Phone: 202-829-7700