Healthcare Provider Details

I. General information

NPI: 1194080689
Provider Name (Legal Business Name): PHS GENERAL SURGRY DP318
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE DEPAUL 318
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1150 VARNUM ST NE ST CATHERINE'S HALL, ROOM 102
WASHINGTON DC
20017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-4014
  • Fax: 301-262-8291
Mailing address:
  • Phone: 202-854-4014
  • Fax: 301-262-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberHFD01-0212
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHFD01-0212
License Number StateDC

VIII. Authorized Official

Name: MR. GREGORY ZIEGLER
Title or Position: AVP FINANCE
Credential:
Phone: 202-854-7284