Healthcare Provider Details

I. General information

NPI: 1487730636
Provider Name (Legal Business Name): MEDSTAR - GEORGETOWN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD., NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2000 15TH ST., N SUITE 401
ARLINGTON VA
22201-2683
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3000
  • Fax: 202-444-3095
Mailing address:
  • Phone: 703-558-1653
  • Fax: 703-558-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL J WARDA
Title or Position: VP OF FINANCE
Credential:
Phone: 202-444-4724