Healthcare Provider Details

I. General information

NPI: 1154588770
Provider Name (Legal Business Name): WALTER REED ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW BLDG 14
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

6900 GEORGIA AVE NW BLDG 14
WASHINGTON DC
20307-0003
US

V. Phone/Fax

Practice location:
  • Phone: 202-356-1012
  • Fax:
Mailing address:
  • Phone: 202-356-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number09949
License Number StateMD

VIII. Authorized Official

Name: MRS. KARMIN REEVES JENKINS
Title or Position: SOCIAL WORKER
Credential: LCSW C
Phone: 202-356-1012