Healthcare Provider Details

I. General information

NPI: 1730198755
Provider Name (Legal Business Name): MEDSTAR GEORGETOWN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/12/2010
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

PO BOX 631856
BALTIMORE MD
21263-1856
US

V. Phone/Fax

Practice location:
  • Phone: 888-896-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number09D0644931
License Number StateDC

VIII. Authorized Official

Name: STEPHANIE SCHNEIDER
Title or Position: AVP
Credential:
Phone: 703-558-1403