Basic Information
| Provider Information | |||||||||
| NPI: | 1902934045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 NORTH CAPITOL STREET NE | ||||||||
| Address2: | DIRECTORS OFFICE 4TH FLOOR | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024425955 | ||||||||
| FaxNumber: | 2024424795 | ||||||||
| Practice Location | |||||||||
| Address1: | 6323 GEORGIA AVENUE NW | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025767130 | ||||||||
| FaxNumber: | 2025766418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PANE | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2024425955 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
No ID Information.