Provider Demographics
NPI:1225062532
Name:WASHINGTON MEDICAL GROUP
Entity Type:Organization
Organization Name:WASHINGTON MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-744-6706
Mailing Address - Street 1:2557 MOWRY AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1603
Mailing Address - Country:US
Mailing Address - Phone:510-793-3722
Mailing Address - Fax:510-793-8783
Practice Address - Street 1:2557 MOWRY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1603
Practice Address - Country:US
Practice Address - Phone:510-793-3722
Practice Address - Fax:510-793-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty