Healthcare Provider Details

I. General information

NPI: 1881897544
Provider Name (Legal Business Name): WALTER REED NATIONAL MILITARY MEDICAL CNTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE PENTAGON CORRIDOR 8
WASHINGTON DC
20310-0001
US

IV. Provider business mailing address

8901 WISCONSIN AVE PSC BOX 509 CODE 6300
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8700
  • Fax:
Mailing address:
  • Phone:
  • 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: MARCIA DICKSON
Title or Position: FINANCIAL MGMT ANALYST
Credential:
Phone: 301-295-6300