Healthcare Provider Details

I. General information

NPI: 1740269828
Provider Name (Legal Business Name): 52D MEDGRP-SPANGDAHLEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3865
APO AE
09126
DE

IV. Provider business mailing address

UNIT 3865
APO AE
09126
DE

V. Phone/Fax

Practice location:
  • Phone: 4-965-6169
  • Fax: 3144
Mailing address:
  • Phone: 4-965-6169
  • Fax: 3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: JEN LEWANDOWSKI
Title or Position: DEFENSE HEALTH AGENCY (DHA) FINANCI
Credential:
Phone: 703-817-4030