MEDICARE: BRANCH MEDICAL CLINIC WASHINGTON NAVY YARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1265639918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANCH MEDICAL CLINIC WASHINGTON NAVY YARD

Provider Business Mailing Address
First Line	:	8901 WISCONSIN AVE
Second Line	:	PSC BOX 509 CODE 6300
City	:	BETHESDA
State	:	MD
Zip	:	20889-0001
Country	:	US
Telephone Number	:	301-295-4934
Fax Number	:	301-295-1299

Provider Business Practice Location Address
First Line	:	915 N STREET SOUTHEAST
Second Line	:	SUITE 210
City	:	WASHINGTON
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:	202-433-2480
Fax Number	:

Authorized Official
Title or Position	:	NAVY MEDICINE UBO PROGRAM MANAGER
Name	:	MR. WILLIAM MICHAEL CONDON
Credential	:
Telephone Number	:	240-401-3643

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	12/18/2017

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