Healthcare Provider Details

I. General information

NPI: 1154526812
Provider Name (Legal Business Name): WRAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 3RD AVE SW
FORT MCNAIR DC
20024-5120
US

IV. Provider business mailing address

9300 DEWITT LOOP FBCH OTPT TPCP
FT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-2856
  • Fax:
Mailing address:
  • Phone: 571-231-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: OSCAR HARTLEY
Title or Position: UBO MANAGER
Credential:
Phone: 571-231-2866