Healthcare Provider Details

I. General information

NPI: 1821444373
Provider Name (Legal Business Name): JEFFREY BENDER AA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE DEPT OF
WASHINGTON DC
20017-2180
US

IV. Provider business mailing address

1150 VARNUM STREET, NE ST. CATHERINE HALL/1ST FL/RM 102
WASHINGTON DC
20017-2014
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-4041
  • Fax: 202-854-4034
Mailing address:
  • Phone: 202-854-4041
  • Fax: 202-854-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2016
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA000096
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: