NPI 1164521019 · live from the CMS NPI Registry
Momodu A Jack, M.D.
Internal Medicine, Gastroenterology in Washington, DC. National Provider Identifier 1164521019, active.
NPI record
| NPI | 1164521019 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine, Gastroenterology 207RG0100X |
| Practice location | 2139 Georgia Ave Nw, Suite 3a, Washington, DC 20001 |
| Practice phone | 202-865-7981 |
| Mailing address | Po Box 2325, Columbia, MD 21045 |
| Enumerated | September 21, 2006 |
| Last updated | November 6, 2020 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine, Gastroenterology | 207RG0100X | D0044035 (MD) |
| Internal Medicine, Gastroenterology | 207RG0100X | 0101270422 (VA) |
| Internal Medicine, Gastroenterology primary | 207RG0100X | MD20286 (DC) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.