Healthcare Provider Details

I. General information

NPI: 1528421500
Provider Name (Legal Business Name): REX EUGENE ATWOOD III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE DEPARTMENT OF GENERAL SURGERY
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE DEPARTMENT OF GENERAL SURGERY
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101264418
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: