Provider Demographics
NPI:1114190410
Name:NATIONAL NAVAL MEDICAL CENTER - NEPHROLOGY DIVISION
Entity Type:Organization
Organization Name:NATIONAL NAVAL MEDICAL CENTER - NEPHROLOGY DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIALYSIS DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:N
Authorized Official - Last Name:PASIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-295-4330
Mailing Address - Street 1:8901 WISCONSIN AVE
Mailing Address - Street 2:NEPHROLOGY DIVISON 4E
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-4330
Mailing Address - Fax:301-295-6081
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:NEPHROLOGY DIVISON 4E
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4330
Practice Address - Fax:301-295-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21007FMedicare UPIN