Healthcare Provider Details

I. General information

NPI: 1164675773
Provider Name (Legal Business Name): CHILDREN'S NATIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4013
  • Fax:
Mailing address:
  • Phone: 202-476-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number16339
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number2305001401
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberPT711
License Number StateDC

VIII. Authorized Official

Name: MS. SUSAN PFENNING
Title or Position: MANAGER MEDICAL AND ACADEMIC AFFAIR
Credential:
Phone: 202-476-4447