Healthcare Provider Details

I. General information

NPI: 1770554107
Provider Name (Legal Business Name): US ARMY WALTER REED ARMY MED CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 N PARK AVE #1009
CHEVY CHASE MD
20815-4519
US

IV. Provider business mailing address

6900 GEORGIA AVE NW
WASHINGTON DC
20307-0003
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-1560
  • Fax:
Mailing address:
  • Phone: 202-782-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number2865M2000X
License Number StateTX

VIII. Authorized Official

Name: MS. JILL ELIZABETH FOWLER
Title or Position: CLINICAL DIETITIAN
Credential: RD
Phone: 210-274-9969