Organization
GUH KIDS MOBILE MEDICAL CLINIC PROGRAM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE SCHNEIDER (VP)
(703) 558-1403
Entity
Organization
Contact information
Practice address
3800 RESERVOIR RD NW, WASHINGTON, DC 20007-2113
(202) 444-0075
Mailing address
PO BOX 418283, BOSTON, MA 02241-8283
(703) 558-1400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G0065
MEDICARE GROUP NUMBER
DC
Enumeration date
08/04/2006
Last updated
03/28/2024
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