Provider Demographics
NPI:1780695973
Name:PULMONARY CRITICAL CARE ASSOCIATES, PC
Entity type:Organization
Organization Name:PULMONARY CRITICAL CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIUS
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:POLK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:202-526-5491
Mailing Address - Street 1:1160 VARNUM ST NE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2107
Mailing Address - Country:US
Mailing Address - Phone:202-526-5491
Mailing Address - Fax:202-526-5434
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 214
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-526-5491
Practice Address - Fax:202-526-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00085Medicare ID - Type Unspecified