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General NPI Number Information
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NPI Number | 1295987436
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Entity Type | Organization
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Legal Business Name | MAMONLUK CHUA MEDICAL GROUP, PC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE SUITE # 008
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City | WASHINGTON
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State | DC
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Zip | 20017-2110
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Country | US
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Telephone | 202-526-3897
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Fax | 202-526-7723
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Provider Business Mailing Address
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Address Line | 1160 VARNUM ST NE SUITE # 008
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City | WASHINGTON
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State | DC
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Zip | 20017-2110
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Country | US
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Telephone | 202-526-3897
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Fax | 202-526-7723
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Authorized Official
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Title or Position | PRESIDENT
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Name | FERDINAND P CHUA
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Credential | MD
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Telephone | 202-526-3897
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD037327
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD037395
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License Number State | DC
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