| Dervan Healthcare Services LLC | |
|
3849 Pennsylvania Ave Se Washington DC 20020-1309 | |
| (301) 728-3783 | |
| Not Available |
| Full Name | Dervan Healthcare Services LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 3849 Pennsylvania Ave Se, Washington, District Of Columbia |
| Authorized Official Name and Position | Blanche Mokoso (FNP) |
| Authorized Official Contact | 3017283783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dervan Healthcare Services LLC 11303 Springpark Ct Glenn Dale MD 20769-9611 Ph: (301) 728-3783 | Dervan Healthcare Services LLC 3849 Pennsylvania Ave Se Washington DC 20020-1309 Ph: (301) 728-3783 |
| NPI Number | 1275182560 |
|---|---|
| Provider Enumeration Date | 09/09/2019 |
| Last Update Date | 09/10/2020 |
| Certification Date | 08/11/2020 |
| Medicare PECOS PAC ID | 6406280254 |
|---|---|
| Medicare Enrollment ID | O20201029000961 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275182560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Blanche Mokoso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356867360 PECOS PAC ID: 7214361062 Enrollment ID: I20201029001060 |
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