Provider Demographics
NPI:1669565495
Name:DOUOGUIH, WIEMI ABELL (MD)
Entity type:Individual
Prefix:
First Name:WIEMI
Middle Name:ABELL
Last Name:DOUOGUIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-291-9266
Mailing Address - Fax:202-291-0886
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 215
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-291-9266
Practice Address - Fax:202-291-0886
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034358207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4566-0010OtherCAREFIRST BLUE CROSS
DCP00150571OtherRAILROAD MEDICARE
DCP00150571OtherRAILROAD MEDICARE
DCH80938Medicare UPIN
DC012293ZD7EMedicare PIN