Provider Demographics
NPI:1912777475
Name:1530 MEDICAL SERVICES
Entity Type:Organization
Organization Name:1530 MEDICAL SERVICES
Other - Org Name:1530 MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKONOFUA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:301-732-9443
Mailing Address - Street 1:1160 VARNUM ST NE STE 218
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2106
Mailing Address - Country:US
Mailing Address - Phone:202-269-6600
Mailing Address - Fax:
Practice Address - Street 1:1160 VARNUM ST NE STE 218
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2106
Practice Address - Country:US
Practice Address - Phone:202-269-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)