Organization
BENNING ROAD PRIMARY CARE PC
Active
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
Update your record
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