Basic Information
Provider Information
NPI: 1508363706
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAJDI
FirstName: JAMIE
MiddleName: CARPENTER
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CARPENTER
OtherFirstName: JAMIE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3020 14TH ST NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200096865
CountryCode: US
TelephoneNumber: 2024694699
FaxNumber:  
Practice Location
Address1: 3020 14TH ST NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200096865
CountryCode: US
TelephoneNumber: 2024694699
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/12/2018
LastUpdateDate: 02/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD049379DCY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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