Provider Demographics
NPI:1992124671
Name:GEORGE WASHINGTON UNIVERSITY
Entity type:Organization
Organization Name:GEORGE WASHINGTON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENCY
Authorized Official - Prefix:
Authorized Official - First Name:XIAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-556-9839
Mailing Address - Street 1:2150 PENNSYLVANIA AVENUE, NW
Mailing Address - Street 2:THE GW MEDICAL FACULTY ASSOCIATES
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037
Mailing Address - Country:US
Mailing Address - Phone:202-741-3000
Mailing Address - Fax:
Practice Address - Street 1:19 S CASTLEROCK LN
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1493
Practice Address - Country:US
Practice Address - Phone:803-556-9839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRAX881219229Medicaid