Healthcare Provider Details

I. General information

NPI: 1750639050
Provider Name (Legal Business Name): CHILDREN'S NATIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

4431 CHASE PARK CT
ANNANDALE VA
22003-5743
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberRN1009755
License Number StateDC

VIII. Authorized Official

Name: DR. SARAH REBSTOCK
Title or Position: PAIN CLINIC DIRECTOR
Credential: MD
Phone: 202-476-4000