Healthcare Provider Details

I. General information

NPI: 1215341763
Provider Name (Legal Business Name): MEDICAL FACULTY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW SUITE 6-B
WASHINGTON DC
20037-3201
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW SUITE 6-B
WASHINGTON DC
20037-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-3203
  • Fax: 202-741-3219
Mailing address:
  • Phone: 202-741-3203
  • Fax: 202-741-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN965339
License Number StateDC

VIII. Authorized Official

Name: STEPHEN BADGER
Title or Position: CEO
Credential:
Phone: 202-741-3000