PHS MEDICAL SPECIALISTS PMB107 (NPI# 1457693012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457693012 |
| Entity Type | Organization |
| Organization Name | PHS MEDICAL SPECIALISTS PMB107 |
| Other Organization Name | PROVIDENCE HEALTH SERVICES |
| Practice Address |
1140 Varnum St Ne Pmb107 Washington DC 20017-2151 |
| Mailing Address |
1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 |
| Practice Telephone | 2028544052 |
| Practice Fax Number | 2028544832 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2028547825 |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2016-09-06 |
| Authorized Official Name | MR. CHARLES F HABERKERN (VP) |
| Authorized Official Telephone | 2028544255 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282N00000X | General Acute Care Hospital | HFD01-0212 | DC | Hospitals |
| Y | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DC | 029833400 | 05 | |
| MD | 005145400 | 05 | |
| VA | 09810714 | 05 |
| Other Name | Type Code |
|---|---|
| Providence Health Services | Other Name - Individual/Organization |
| Street Address |
1140 VARNUM ST NE PMB107 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194725184 | Gail S Kerr | Internal Medicine | 1140 Varnum St Ne, Suite #201, Washington, DC 20017-2151 | 2005-07-31 |
| 1144641713 | Capital Consulting Services, LLC | Internal Medicine | 1140 Varnum St Ne, Pmb 105, Washington, DC 20017-2151 | 2013-12-26 |
| 1710240114 | Dal Yoo Md LLC | Internal Medicine | 1140 Varnum St Ne, Suite 102, Washington, DC 20017-2151 | 2012-06-20 |
| 1366710766 | Providence Health Services, Inc | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 200, Washington, DC 20017-2151 | 2011-12-13 |
| 1750659272 | Phs Family Medicine & Pediatrics Pmb103 | Pediatrics | 1140 Varnum St Ne, Pmb103, Washington, DC 20017-2151 | 2011-12-12 |
| 1326316936 | Phs Internal Medicine Pmb202 | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 202, Washington, DC 20017-2151 | 2011-12-09 |
| 1457666000 | Nana Yaw Asamoah-mensah, M.d.,p.c. | Psychiatry & Neurology | 1140 Varnum St Ne, Suite 205, Washington, DC 20017-2153 | 2010-08-06 |
| 1730492422 | Andre S Michalak Md PC | Clinic/Center | 1140 Varnum St Ne, Suite 208b, Washington, DC 20017-2151 | 2010-07-22 |
| 1922335561 | Bustos & Associates, LLC | Preferred Provider Organization | 1140 Varnum St Ne, Pmb 105, Washington, DC 20017-2151 | 2009-11-03 |
| 1740415264 | Mikel Anne Hofmann | Family Medicine | 1140 Varnum St Ne, Ste 200, Washington, DC 20017-2153 | 2009-05-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588215479 | Janet Achankeng Folem | Psychologist | 7100 Varnum St Ne, Suit 218, Washington, DC 20017 | 2019-09-23 |
| 1013475284 | Raphaelia Agnes Johnson-phillips | Technician | 440 Taylor St. Ne Building B Apt 22, Washington Dc, DC 20017 | 2019-03-06 |
| 1528551413 | Harpreet Saluja | Student in an Organized Health Care Education/Training Program | 1150 Varnum St Ne, Providence Hospital Im Department, Washington, DC 20017 | 2018-06-14 |
| 1134638042 | Jane Hayashi-kim | Speech-Language Pathologist | 3910 9th St Ne, Apartment 3, Washington, DC 20017 | 2017-09-22 |
| 1346766102 | Aaliyah Gabrielle Jones | Technician | 611edgewood Ne, Washington, DC 20017 | 2017-08-14 |
| 1417479197 | Javalin Singh | Home Health Aide | Hsc Pediatric Center 1731 Bunker Hill Rd, Washington, DC 20017 | 2017-07-13 |
| 1386174175 | Genevieve Wells | Home Health Aide | 601 Edgewood St. Ne, Apt 706, Washington, DC 20017 | 2017-06-14 |
| 1487183810 | Valerie Anne Pierre | Student in an Organized Health Care Education/Training Program | 1150 Varnum Street, N.e., Acc 209, Washington, DC 20017 | 2017-06-08 |
| 1639600984 | Liliana Tatum | Counselor | 1428 Hamlin Street Ne, Washington, DC 20017 | 2017-03-27 |
| 1750835435 | Marie Hortense Mabou Sando | Home Health Aide | 1416 9th Street Nwdc, Washington, DC 20017 | 2016-08-10 |
| Find all providers in zip 20017 | ||||
| Taxonomy Code | 207RI0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Infectious Disease |
| An internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this special skill. This physician often diagnoses and treats AIDS patients and patients with fevers which have not been explained. Infectious disease specialists may also have expertise in preventive medicine and travel medicine. |
| 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 |
|---|---|---|---|---|
| 1508252057 | Ronald Matthias Beaulieu IIi | Internal Medicine | 3800 Reservoir Rd Nw Fl 5, Washington, DC 20007-2113 | 2015-04-11 |
| 1124432745 | Michael Charles Mccarthy | Internal Medicine | 1900 Vermont Ave Nw, Washington, DC 20001-8066 | 2014-06-12 |
| 1174960637 | Shannon Lee Hader | Internal Medicine | 1332 Farragut St Nw, Washington, DC 20011-6908 | 2013-05-23 |
| 1972813608 | Anthony Stephen Fauci | Internal Medicine | 3012 - 43rd Street, N.w., Washington, DC 20016-3547 | 2010-10-15 |
| 1467767830 | Amanuel Tekle Rosario | Internal Medicine | 1900 Massachusetts Ave Se Bldg 15, Washington, DC 20003-2542 | 2010-08-10 |
| 1255659223 | Washington Physician Services Organization | Internal Medicine | 95 Leonard Ave Ste 104, Washington, PA 15301-3368 | 2010-05-14 |
| 1477794576 | Ethio-american Health Center Inc | Internal Medicine | 4515 14th St Nw, Washington, DC 20011-4358 | 2009-03-19 |
| 1548437106 | Jhansi Lakshmi Gajjala | Internal Medicine | 2139 Georgia Nwave 3rd, Washington, DC 20001-3035 | 2008-05-13 |
| 1902086457 | Raul E. Isturiz | Internal Medicine | Us Dept of State M/med/qi Sa1, 2401 E Street Nw, Washington, DC 20522-0001 | 2007-11-13 |
| 1912197096 | Andrea N Meyerhoff | Internal Medicine | Georgetown University Med Ctr, Washington, DC 20007 | 2007-07-26 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20017 |
Please comment or provide details below to improve the information on PHS MEDICAL SPECIALISTS PMB107.
| 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.