Provider Demographics
NPI:1699816363
Name:WASHINGTON CENTER FOR DIABETES AND ENDOCRINOLOGY,LLC.
Entity Type:Organization
Organization Name:WASHINGTON CENTER FOR DIABETES AND ENDOCRINOLOGY,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-564-6003
Mailing Address - Street 1:PO BOX 341644
Mailing Address - Street 2:
Mailing Address - City:W BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20827-1644
Mailing Address - Country:US
Mailing Address - Phone:301-564-6003
Mailing Address - Fax:301-564-5202
Practice Address - Street 1:6320 DEMOCRACY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1664
Practice Address - Country:US
Practice Address - Phone:301-564-6003
Practice Address - Fax:301-564-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02709Medicare PIN