Healthcare Provider Details

I. General information

NPI: 1720292501
Provider Name (Legal Business Name): ALEXANDER T AUGUSTA MED CTR-FT BELVOIR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE PENTAGON
WASHINGTON DC
20310-5600
US

IV. Provider business mailing address

8901 WISCONSIN AVE PSC BOX 509 CODE 6300
BETHESDA MD
20889-5600
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MICHAEL CONDON
Title or Position: DHA UBO
Credential:
Phone: 240-401-3643