Provider Demographics
NPI:1356759484
Name:CAROL C. JAGDEO, MD. L.L.C
Entity type:Organization
Organization Name:CAROL C. JAGDEO, MD. L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:JAGDEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-877-0532
Mailing Address - Street 1:106 IRVING STREET NW
Mailing Address - Street 2:SUITE 406 SOUTH
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-0510
Mailing Address - Fax:202-877-9088
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 406 SOUTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-0510
Practice Address - Fax:202-877-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14312261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC342017092Medicare PIN
DCB94334Medicare UPIN