| Revolution Medicine Health & Fitness Pllc | |
|
1050 Connecticut Ave Nw Ste 500 Washington DC 20036-5304 | |
| (202) 596-8891 | |
| (304) 245-6029 |
| Full Name | Revolution Medicine Health & Fitness Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 1050 Connecticut Ave Nw Ste 500, Washington, District Of Columbia |
| Authorized Official Name and Position | Michael L Glickman (PHYSICIAN) |
| Authorized Official Contact | 2025968891 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolution Medicine Health & Fitness Pllc 1050 Connecticut Ave Nw Ste 500 Washington DC 20036-5304 Ph: (202) 596-8891 | Revolution Medicine Health & Fitness Pllc 1050 Connecticut Ave Nw Ste 500 Washington DC 20036-5304 Ph: (202) 596-8891 |
| NPI Number | 1245887959 |
|---|---|
| Provider Enumeration Date | 08/19/2019 |
| Last Update Date | 12/09/2019 |
| Medicare PECOS PAC ID | 7911339890 |
|---|---|
| Medicare Enrollment ID | O20191114001018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245887959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Glickman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033559695 PECOS PAC ID: 3870713647 Enrollment ID: I20140929001504 |
| Provider Name | Jewel B Osborne-wu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003175589 PECOS PAC ID: 6305069865 Enrollment ID: I20161005000162 |
| Provider Name | Renee Hadeed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114454196 PECOS PAC ID: 7810269263 Enrollment ID: I20170818001867 |
| Provider Name | Deirdra Tiffany |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255995692 PECOS PAC ID: 8820331697 Enrollment ID: I20190517000997 |
| Provider Name | Tiffany Dirickson-ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306472717 PECOS PAC ID: 3072906668 Enrollment ID: I20230425000739 |
| Provider Name | Samantha M Brand |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437545340 PECOS PAC ID: 8820302425 Enrollment ID: I20240716001068 |
| Provider Name | Richele Corrado |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285920728 PECOS PAC ID: 0345470522 Enrollment ID: I20250219003464 |
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