Healthcare Provider Details

I. General information

NPI: 1285988782
Provider Name (Legal Business Name): BREAST CARE FOR WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ATLANTIC ST SW
WASHINGTON DC
20032-2350
US

IV. Provider business mailing address

4 ATLANTIC ST SW
WASHINGTON DC
20032-2350
US

V. Phone/Fax

Practice location:
  • Phone: 202-465-7164
  • Fax: 202-905-0159
Mailing address:
  • Phone: 202-465-7164
  • Fax: 202-905-0159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REGINA HAMPTON
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 301-552-7805