Provider Demographics
NPI:1902934045
Name:DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-442-5955
Mailing Address - Street 1:825 NORTH CAPITOL STREET NE
Mailing Address - Street 2:DIRECTORS OFFICE 4TH FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-442-5955
Mailing Address - Fax:202-442-4795
Practice Address - Street 1:6323 GEORGIA AVENUE NW
Practice Address - Street 2:SUITE 305
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-576-7130
Practice Address - Fax:202-576-6418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF00028Medicare ID - Type Unspecified