Healthcare Provider Details

I. General information

NPI: 1265639918
Provider Name (Legal Business Name): BRANCH MEDICAL CLINIC WASHINGTON NAVY YARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 12/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N STREET SOUTHEAST SUITE 210
WASHINGTON DC
20374-5162
US

IV. Provider business mailing address

8901 WISCONSIN AVE PSC BOX 509 CODE 6300
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-433-2480
  • Fax:
Mailing address:
  • Phone: 301-295-4934
  • Fax: 301-295-1299

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: MR. WILLIAM MICHAEL CONDON
Title or Position: NAVY MEDICINE UBO PROGRAM MANAGER
Credential:
Phone: 240-401-3643