MOMODU A JACK (NPI# 1164521019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164521019 |
| Entity Type | Individual |
| Full Name | MOMODU A JACK |
| Credential | M.D. |
| Practice Address |
2139 Georgia Ave Nw Suite 3a Washington DC 20001-3035 |
| Mailing Address |
Po Box 2325 Columbia MD 21045-1325 |
| Practice Telephone | 2028657981 |
| Practice Fax Number | 3016215313 |
| Mailing Telephone | 2028657981 |
| Mailing Fax Number | 3016215313 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-11-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
0101270422 | VA | Allopathic & Osteopathic Physicians |
| N | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
D0044035 | MD | Allopathic & Osteopathic Physicians |
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
MD20286 | DC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | LICENSE | 0101267872 | 01 |
| DC | 018868500 | 05 | |
| MD | 174961700 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 541 Sunset Ln Ste 301, Culpeper, VA 227013979 | 5408254557 | 5408254566 |
| Street Address |
2139 GEORGIA AVE NW SUITE 3A |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20001-3035 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568407898 | Babafemi B Adenuga | Family Medicine | 2139 Georgia Ave Nw, 4th Floor, Washington, DC 20001-3035 | 2006-06-19 |
| 1861855405 | Mubarak Ali Mubarak Hassan | Student in an Organized Health Care Education/Training Program | 2139 Georgia Ave Nw, Suie 3b, Washington, DC 20001-3035 | 2016-03-31 |
| 1679991384 | Ngozi P. Egu | Student in an Organized Health Care Education/Training Program | 2139 Georgia Ave Nw, Suite #3b, Washington, DC 20001-3035 | 2014-03-31 |
| 1487094835 | Ryan Shastri Rabilall | Student in an Organized Health Care Education/Training Program | 2139 Georgia Ave Nw, Suite #3b, Washington, DC 20001-3035 | 2013-06-30 |
| 1376982504 | Fayza Ismail Sohail | Student in an Organized Health Care Education/Training Program | 2139 Georgia Ave Nw, Suite #3b, Washington, DC 20001-3035 | 2013-06-20 |
| 1871852038 | Folasade Osagie | Family Medicine | 2139 Georgia Ave Nw, Suite 3b, Washington, DC 20001-3035 | 2012-05-09 |
| 1730448861 | Ona Pearl Ndu | Hospitalist | 2139 Georgia Ave Nw, Suite 3b, Washington, DC 20001-3035 | 2012-05-09 |
| 1003102831 | Rufina Nwanneka Odigwe | Family Medicine | 2139 Georgia Ave Nw, Suite 3b, Washington, DC 20001-3035 | 2011-06-20 |
| 1588995047 | Chantal Perrier-taylor | Physician Assistant | 2139 Georgia Ave Nw, Howard Univ. Student Health Center, Washington, DC 20001-3035 | 2010-01-23 |
| 1205064201 | Noel Manyindo | Family Medicine | 2139 Georgia Ave Nw, Suite 3-b, Washington, DC 20001-3035 | 2009-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336762673 | Muslimah Annjinnah Shaffi | Home Health Aide | Perry Health System, 128 M Street N.w., Washington Dc, DC 20001 | 2020-05-21 |
| 1275197378 | Marica Donisha Robinette | Home Health | 471 G Place, Nw, #32, Washington, DC 20001 | 2019-04-24 |
| 1689147571 | Maria R Barrera | Counselor | 440 L St Nw, Unit 610, Washington, DC 20001 | 2019-01-03 |
| 1083185086 | Corneesha Donielle Banks | Technician | 307 Kst Nw, #309, Washington, DC 20001 | 2018-12-17 |
| 1548730138 | Briana Shayron Smith | Technician | 150 Q St Ne 1427, Washington, DC 20001 | 2018-11-27 |
| 1235609876 | Edward Bruce Lawson | Technician | 3400 Banneker Dr 425, Northeast, DC 20001 | 2018-11-27 |
| 1740760750 | Minchu Chen | Acupuncturist | 1410, 9th Street Nw #1, First Floor, Washington, DC 20001 | 2018-08-19 |
| 1821574005 | Kimberly Ann Bell | Home Health Aide | 27 O St Nw #4, Washington, DC 20001 | 2018-07-11 |
| 1558859926 | Joan Avis Williams | Home Health Aide | Unique Resident Care Center, 901 First Street Nw, Washington, DE 20001 | 2018-05-01 |
| 1497274088 | Gabriela Andrea Jatene | Speech-Language Pathologist | 450 K Street Nw, Apt 306, Washington, DC 20001 | 2017-09-14 |
| Find all providers in zip 20001 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699924589 | Susan Kaufman Lazerow | Internal Medicine | Dc Va Medical Ctr, 50 Irving Street, Nw, Washington, DC 20422-0001 | 2008-09-16 |
| 1144431552 | Andrew Kent Sanderson II | Internal Medicine | 2401 Georgia Ave Nw, Tower Building, Suite 5100, Washington, DC 20060 | 2007-05-25 |
| 1164639274 | John R Douglas Peterson | Internal Medicine | 901 Patients First Dr Ste 3300, Washington, MO 63090-4700 | 2007-05-17 |
| 1003941378 | Farshad Aduli | Internal Medicine | 2041 Georgia Ave Nw Faculty Practice Plan Suite 5100, Washington, DC 20060-7101 | 2007-02-23 |
| 1558415570 | Shivan Rajkumar Gosine | Internal Medicine | 700 2nd Street, North East, Capitol Hill Medical Center, Washington, DC 20002 | 2007-01-23 |
| 1225134331 | Charles Edward Mcqueen | Internal Medicine | 6900 Georgia Ave Nw Borden Pavillion, Walter Reed Army Medical Center, Washington, DC 20307-0001 | 2006-09-15 |
| 1417064825 | Manhal M Tannous | Internal Medicine | 80 Landing Dr #205, Washington, PA 15301 | 2006-08-23 |
| 1609805704 | Tracy Joy Edwards | Internal Medicine | 4200 Connecticut Ave Nw Bldg 44, Washington, DC 20008-1122 | 2006-07-01 |
| 1598706244 | Michael B Albert | Internal Medicine | 5215 Loughboro Rd Nw Ste 315, Washington, DC 20016-2626 | 2006-06-10 |
| 1356326524 | James Hartman Frank | Internal Medicine | 1133 21st St Nw Ste 601, Washington, DC 20036-3390 | 2005-12-10 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20001 |
Please comment or provide details below to improve the information on MOMODU A JACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.