Healthcare Provider Details

I. General information

NPI: 1558685529
Provider Name (Legal Business Name): JEFFREY L KRASKIN OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MASSACHUSETTS AVE NW
WASHINGTON DC
20016-2362
US

IV. Provider business mailing address

4600 MASSACHUSETTS AVE NW
WASHINGTON DC
20016-2362
US

V. Phone/Fax

Practice location:
  • Phone: 202-363-4450
  • Fax: 202-363-4452
Mailing address:
  • Phone: 202-363-4450
  • Fax: 202-363-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOP482
License Number StateDC

VIII. Authorized Official

Name: DR. JEFFREY LEWIS KRASKIN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 202-363-4450