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General NPI Number Information
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NPI Number | 1659649176
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Entity Type | Organization
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Legal Business Name | PHS BARIATRIC CARE CENTER DP110
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 1160 VARNUM ST NE DEPAUL BUILDING SUITE 110
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-854-4080
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Fax | 202-854-4082
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Provider Business Mailing Address
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Address Line | 1160 VARNUM ST NE ST CATHERINE'S HALL, ROOM 102
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City | WASHINGTON
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State | DC
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Zip | 20017-2107
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Country | US
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Telephone | 202-854-4069
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Fax | 202-854-7825
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Authorized Official
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Title or Position | VP
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Name | MR. CHARLES F HABERKERN
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Credential |
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Telephone | 202-854-4255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | HFD01-0212
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | HFD01-0212
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | HFD01-0212
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License Number State | DC
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