Provider Demographics
NPI:1740550201
Name:OPTIMAL PREVENTIVE MEDICINE, PLLC
Entity type:Organization
Organization Name:OPTIMAL PREVENTIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:202-296-1438
Mailing Address - Street 1:2112 F STREET, NW
Mailing Address - Street 2:SUITE 501
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-296-1438
Mailing Address - Fax:202-296-1549
Practice Address - Street 1:2112 F STREET, NW
Practice Address - Street 2:SUITE 501
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037
Practice Address - Country:US
Practice Address - Phone:202-296-1438
Practice Address - Fax:202-296-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD304445207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3850189OtherCIGNA
00199114007OtherUNITED HEALTH CARE
DCY58800001OtherCAREFIRST BLUE CROSS BLUE SHIELD
DC4284019OtherAETNA
DCY58800001OtherCAREFIRST BLUE CROSS BLUE SHIELD