1265639918 NPI number — BRANCH MEDICAL CLINIC WASHINGTON NAVY YARD

Table of content: (NPI 1265639918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265639918 NPI number — BRANCH MEDICAL CLINIC WASHINGTON NAVY YARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRANCH MEDICAL CLINIC WASHINGTON NAVY YARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265639918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 N STREET SOUTHEAST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20374-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-433-2480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONDON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
NAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official Telephone Number:
240-401-3643

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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