Provider Demographics
NPI:1720292501
Name:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Entity type:Organization
Organization Name:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MGT ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-295-4934
Mailing Address - Street 1:8901 WISCONSIN AVE
Mailing Address - Street 2:PSC BOX 509 CODE 6300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:PSC BOX 509 CODE 6300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-295-4934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639130222OtherPARENT FACILITY NPI EFFECTIVE 1 SEP 2011
1063441905OtherPARENT FACILITY NPI UNTIL 30 AUG 2011
0904119OtherPHARMACY NCPDP
1639130222OtherPARENT FACILITY NPI EFFECTIVE 1 SEP 2011
OTH000Medicare UPIN