Provider Demographics
NPI:1497768519
Name:WASHINGTON MEDICAL GROUP PC
Entity Type:Organization
Organization Name:WASHINGTON MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-785-2400
Mailing Address - Street 1:1327 18TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6516
Mailing Address - Country:US
Mailing Address - Phone:202-785-2400
Mailing Address - Fax:202-452-1853
Practice Address - Street 1:1327 18TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6516
Practice Address - Country:US
Practice Address - Phone:202-785-2400
Practice Address - Fax:202-452-1853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000143103T00000X
DCPSY1000410103T00000X
DCPSY1000844103T00000X
DCPSY1000777103TC0700X
DCCH30016111N00000X
DCCH030070111N00000X
DCMD25570207Q00000X
DCMD33444207V00000X
DCMD188122084N0400X
DCMD188132084N0400X
DCPA030558363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
411459Medicare ID - Type Unspecified