Healthcare Provider Details

I. General information

NPI: 1659299733
Provider Name (Legal Business Name): UROLOGIC SURGEONS OF WASHINGTON CHTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 20TH ST NW STE 400
WASHINGTON DC
20036-3464
US

IV. Provider business mailing address

1147 20TH ST NW STE 400
WASHINGTON DC
20036-3464
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-1024
  • Fax: 202-223-2152
Mailing address:
  • Phone: 202-223-1024
  • Fax: 202-223-2152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RUBITH MACIAS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 202-223-1025