Provider Demographics
NPI:1780708669
Name:KABATSI, DIDACE (MD)
Entity type:Individual
Prefix:DR
First Name:DIDACE
Middle Name:
Last Name:KABATSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 18TH ST NW STE 620
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-3513
Mailing Address - Country:US
Mailing Address - Phone:202-822-9600
Mailing Address - Fax:202-822-8099
Practice Address - Street 1:818 18TH ST NW STE 620
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3513
Practice Address - Country:US
Practice Address - Phone:202-822-9600
Practice Address - Fax:202-822-8099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD9107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD9107OtherMEDICAL LICENSE NO
DCMD9107OtherMEDICAL LICENSE NO
DCB93342Medicare UPIN