Provider Demographics
NPI:1215582978
Name:HOWARD UNIVERSITY
Entity Type:Organization
Organization Name:HOWARD UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-865-6679
Mailing Address - Street 1:2041 GEORGIA AVE NW STE 6101
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:
Practice Address - Street 1:4414-4430 BENNING ROAD, NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019
Practice Address - Country:US
Practice Address - Phone:202-865-2120
Practice Address - Fax:202-396-2030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC082068700Medicaid
DC034501300Medicaid
DC034504600Medicaid
DC034508700Medicaid
DC034507900Medicaid
DC034503800Medicaid