Jack, Momodu A
Jack, Momodu A is an sole proprietor health care provider with primary practice located at 2139 Georgia Ave Nw Suite 3A, Washington DC 20001-3035. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Jack, Momodu A can be contacted via phone (202) 865-7981.Contact Information
Primary practice address
2139 Georgia Ave Nw Suite 3A
Washington DC 20001-3035
Phone: (202) 865-7981
Fax: (301) 621-5313
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | D0044035 | Maryland |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 0101270422 | Virginia |
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | MD20286 | District of Columbia |
Profile Details
| NPI number | 1164521019 |
|---|---|
| LBN Legal business name | Jack, Momodu A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 21st, 2006 |
| Last updated | Nov 6th, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164521019 | NPPES |
| Virginia | Other | 0101267872 | LICENSE |
| Virginia | MEDICAID | 174961700 | LICENSE |
| Virginia | MEDICAID | 018868500 | LICENSE |
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