Healthcare Provider Details

I. General information

NPI: 1356568109
Provider Name (Legal Business Name): DOHAPRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E ST SE BLDG 13
WASHINGTON DC
20003-2593
US

IV. Provider business mailing address

1300 1ST ST NE RM 315
WASHINGTON DC
20002-3335
US

V. Phone/Fax

Practice location:
  • Phone: 202-698-3773
  • Fax: 202-727-0206
Mailing address:
  • Phone: 202-727-9569
  • Fax: 202-727-0092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAH7100059
License Number StateDC

VIII. Authorized Official

Name: DR. CHARLES HALL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 202-727-8941