Provider Demographics
NPI:1306160502
Name:METRO MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:METRO MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDEV
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-398-2897
Mailing Address - Street 1:1647 BENNING RD NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4569
Mailing Address - Country:US
Mailing Address - Phone:202-398-2897
Mailing Address - Fax:
Practice Address - Street 1:1647 BENNING RD NE
Practice Address - Street 2:SUITE 202
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4569
Practice Address - Country:US
Practice Address - Phone:202-398-2897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030059111N00000X
DCMD21289208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty