Healthcare Provider Details

I. General information

NPI: 1841686557
Provider Name (Legal Business Name): UNITED STATES ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

302 NICHOLAS DR
DELRAN NJ
08075-1352
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-8164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberRN610761
License Number StatePA

VIII. Authorized Official

Name: CHARLES HARKINS
Title or Position: CRNA
Credential: CRNA
Phone: 856-296-5490