Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
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Phs Family Medicine & Pediatrics Pmb103

Organization Family Medicine Physician · NPI 1750659272

Phs Family Medicine & Pediatrics Pmb103 provides Family Medicine Physician services 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 Not confirmed with CMS for 10 years — call before visiting
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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