Healthcare Provider Details

I. General information

NPI: 1376603514
Provider Name (Legal Business Name): U.S. DEPARTMENT OF STATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E STREET NW M.MED.QI, SA-1
WASHINGTON DC
20522-0102
US

IV. Provider business mailing address

2401 E STREET NW M.MED.QI, SA-1
WASHINGTON DC
20522-0102
US

V. Phone/Fax

Practice location:
  • Phone: 202-663-2453
  • Fax: 202-663-3247
Mailing address:
  • Phone: 202-663-2453
  • Fax: 202-663-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT G. BURNEY
Title or Position: DIRECTOR, QUALITY IMPROVEMENT
Credential: MD
Phone: 202-663-2453