Provider Demographics
NPI:1477701217
Name:DISTRICT PODIATRY, PLLC
Entity Type:Organization
Organization Name:DISTRICT PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUBRINA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOUIS-JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-388-5303
Mailing Address - Street 1:1647 BENNING RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4569
Mailing Address - Country:US
Mailing Address - Phone:202-388-5303
Mailing Address - Fax:202-388-5305
Practice Address - Street 1:1647 BENNING RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4569
Practice Address - Country:US
Practice Address - Phone:202-388-5303
Practice Address - Fax:202-388-5305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCP01000007213E00000X
VA0103300768213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC22390OtherDC CHARTERED
GA480032058OtherRAILROAD MEDICARE
DC4699OtherBRAVO
VA9304151Medicaid
DC0170242700Medicaid
DC2155212OtherUNITED HEALTHCARE
DC2155212OtherUNITED HEALTHCARE
DC4699OtherBRAVO
DCU78935Medicare UPIN