Healthcare Provider Details

I. General information

NPI: 1356484851
Provider Name (Legal Business Name): DEPARTMENT OF HEALTH WAREHOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 DC VILLAGE LANE SW
WASHINGTON DC
20032-5205
US

IV. Provider business mailing address

4 DC VILLAGE LANE SW
WASHINGTON DC
20032-5205
US

V. Phone/Fax

Practice location:
  • Phone: 202-645-6217
  • Fax: 202-645-6263
Mailing address:
  • Phone: 202-645-6217
  • Fax: 202-645-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberDW0100023
License Number StateDC

VIII. Authorized Official

Name: DR. GREGG PANE
Title or Position: DIRECTOR DC DEPARTMENT
Credential:
Phone: 202-442-5954