Provider Demographics
NPI:1093252744
Name:CNMC CLINIC AT DUNBAR HS
Entity Type:Organization
Organization Name:CNMC CLINIC AT DUNBAR HS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PFENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-476-4447
Mailing Address - Street 1:PO BOX 37215
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 N STREET, NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2377
Practice Address - Country:US
Practice Address - Phone:202-476-4447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-19
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental