Provider Demographics
NPI:1912017500
Name:WILLIAM J. WASHINGTON M.D.,INC
Entity Type:Organization
Organization Name:WILLIAM J. WASHINGTON M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-382-4974
Mailing Address - Street 1:5 SEVERANCE CIRCLE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-382-4974
Mailing Address - Fax:216-382-4981
Practice Address - Street 1:5 SEVERANCE CIRCLE
Practice Address - Street 2:SUITE 107
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118
Practice Address - Country:US
Practice Address - Phone:216-382-4974
Practice Address - Fax:216-382-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH697760261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care