Provider Demographics
NPI:1063541266
Name:GEORGETOWN UNIVERSITY HOSPITAL
Entity type:Organization
Organization Name:GEORGETOWN UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:202-444-5479
Mailing Address - Street 1:6606 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5223
Mailing Address - Country:US
Mailing Address - Phone:703-992-7094
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-5479
Practice Address - Fax:202-444-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1006032282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital