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NPI Code Detail

MEDICARE: BRANCH MEDICAL CLINIC INDIAN HEAD

MEDICARE: BRANCH MEDICAL CLINIC INDIAN HEAD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1100XMilitary/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number : 1841498417
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRANCH MEDICAL CLINIC INDIAN HEAD
Provider Business Mailing Address
First Line : 4141 W WILSON RD
Second Line : SUITE105
City : INDIAN HEAD
State : MD
Zip : 20640-5162
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4141 W WILSON RD
Second Line : SUITE105
City : INDIAN HEAD
State : MD
Zip : 20640-5162
Country : US
Telephone Number : 301-744-4601
Fax Number :
Authorized Official
Title or Position : NAVY MEDICINE UBO PROGRAM MANAGER
Name : MR. WILLIAM MICHAEL CONDON
Credential :
Telephone Number : 240-401-3643
Provider Enumeration Date : 07/05/2007
Last Update Date : 12/19/2017

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Directions to “BRANCH MEDICAL CLINIC INDIAN HEAD ” Practice Location

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