Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Phs Family Medicine & Pediatrics Pmb103

Organization Family Medicine Physician · NPI 1750659272

Phs Family Medicine & Pediatrics Pmb103 is a Family Medicine Physician in Washington, District of Columbia. Licensed in District of Columbia. Registered with an NPI since 2011.

Licensed in
DC
In the registry since
2011
Specialties on file
3
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Practice location Address checks out

1140 Varnum St NE PMB103
Washington, DC 20017-2151
Phone: (202) 854-7074
Fax: (202) 854-7470
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence HFD01-0212 (DC)
Pediatrics Physician Taxonomy 208000000X · Licence HFD01-0212 (DC)
General Acute Care Hospital Taxonomy 282N00000X · Licence HFD01-0212 (DC)

Record details

NPI number1750659272
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Hospital
Authorized official Charles Haberkern — Vp · (202) 854-4255
Other names Providence Health Services
NPI enumeratedDecember 12, 2011
Last updated in NPPESSeptember 6, 2016
Mailing address1160 Varnum St Ne, St Catherine'S Hall, Room 102, Washington, DC 20017-2107

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