Organization
BENNING ROAD PRIMARY CARE AND PYSICIAN WIEGHT LOSS PC
Active
Organization
BENNING ROAD PRIMARY CARE AND PYSICIAN WIEGHT LOSS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISMAIL MUSTAPHA KALOKOH MD. (CEO)
(202) 397-2200
Entity
Organization
Contact information
Practice address
1647 BENNING RD NE, SUITE 304, WASHINGTON, DC 20002-4569
(202) 397-2200
(202) 397-2688
Mailing address
1647 BENNING RD NE, SUITE 304, WASHINGTON, DC 20002-4569
(202) 397-2200
(202) 397-2688
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D0047927
MD
207R00000X
Internal Medicine Physician
Primary
MD21581
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017134100
—
DC
05
—
024304300
—
MD
Enumeration date
01/12/2010
Last updated
01/12/2010
Update your record
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