Healthcare Provider Details

I. General information

NPI: 1518391267
Provider Name (Legal Business Name): MEDSTAR GEORGETOWN UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW BLES BUILDING
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

1024 N UTAH ST APT 121
ARLINGTON VA
22201-5734
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-5592
  • Fax:
Mailing address:
  • Phone: 610-389-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberOT010000878
License Number StateDC

VIII. Authorized Official

Name: MISS MELISSA THERESA TIERNAN
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 610-389-5073