Provider Demographics
NPI:1093773251
Name:WASHINGTON PEDIATRIC ASSOC
Entity Type:Organization
Organization Name:WASHINGTON PEDIATRIC ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-955-5625
Mailing Address - Street 1:PO BOX 33879
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20033
Mailing Address - Country:US
Mailing Address - Phone:202-955-5625
Mailing Address - Fax:202-955-5626
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:#708
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-955-5625
Practice Address - Fax:202-955-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty