Healthcare Provider Details

I. General information

NPI: 1639130222
Provider Name (Legal Business Name): WALTER REED NATIONAL MILITARY MEDICAL CNTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC BOX 509 CODE 6300 8901 WISCONSIN AVENUE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-295-4934
  • Fax: 301-319-8798
Mailing address:
  • Phone: 301-295-4189
  • Fax: 301-319-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number StateMD

VIII. Authorized Official

Name: CHERYL GARDNER
Title or Position: UBO MANAGER
Credential:
Phone: 301-295-1773