Organization
BENNING ROAD PRIMARY CARE 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
PO BOX 3703, CAPITOL HEIGHTS, MD 20791-3703
(202) 397-2200
(202) 397-2688
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD21581
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017134100
—
DC
Enumeration date
02/22/2012
Last updated
02/22/2012
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