Healthcare Provider Details

I. General information

NPI: 1568437234
Provider Name (Legal Business Name): AIR FORCE MEDICAL OPERATIONS AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 FRAIM STREET AFMOA/SGXS
FREDERICK MD
21702
US

IV. Provider business mailing address

525 FRAIM STREET AFMOA/SGXS
FREDERICK MD
21702
US

V. Phone/Fax

Practice location:
  • Phone: 301-619-7504
  • Fax: 301-619-2417
Mailing address:
  • Phone: 301-619-7504
  • Fax: 301-619-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN S. BROCKMAN
Title or Position: SGOC
Credential:
Phone: 202-404-7361