Provider Demographics
NPI: | 1033163597 |
---|---|
Name: | HOWARD UNIVERSITY |
Entity Type: | Organization |
Organization Name: | HOWARD UNIVERSITY |
Other - Org Name: | FACULTY PRACTICE PLAN HOWARD UNIVERSITY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT, HOWARD UNIVERSITY |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | WAYNE |
Authorized Official - Middle Name: | IA |
Authorized Official - Last Name: | FREDERICK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD, MBA |
Authorized Official - Phone: | 202-865-7470 |
Mailing Address - Street 1: | 2041 GEORGIA AVE NW SUITE 3400 - TOWERS 3RD FL |
Mailing Address - Street 2: | |
Mailing Address - City: | WASHINGTON |
Mailing Address - State: | DC |
Mailing Address - Zip Code: | 20060-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | 202-865-1617 |
Practice Address - Street 1: | 2041 GEORGIA AVE NW |
Practice Address - Street 2: | |
Practice Address - City: | WASHINGTON |
Practice Address - State: | DC |
Practice Address - Zip Code: | 20060-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-865-6100 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HOWARD UNIVERSITY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-05-20 |
Last Update Date: | 2023-03-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DC | 207L00000X, 207Q00000X, 207R00000X, 207V00000X, 207W00000X, 207X00000X, 207ZP0105X, 208000000X, 2084N0400X, 2084P0800X, 2085R0202X, 208600000X, 235Z00000X | |
207N00000X, 261QM1300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207ZP0105X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
G01113 | Other | MEDICARE GROUP NUMBER |