=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083626451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON GASTROENTEROLOGY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 10/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 IRVING ST NW STE 205
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20010-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-829-0170
-----------------------------------------------------
Fax | 202-829-2927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 70608
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20813-0608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-829-0022
-----------------------------------------------------
Fax | 202-829-2927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOOKKEEPER
-----------------------------------------------------
Name | MISS LISA MARIE LAMB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-829-0022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------