Provider Demographics
NPI:1205042926
Name:WRAMC
Entity Type:Organization
Organization Name:WRAMC
Other - Org Name:DILORENZO TRICARE HEALTH CLINIC ARLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-231-2866
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:ATTN FBCH OTPT TPCP
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5901
Mailing Address - Country:US
Mailing Address - Phone:571-231-2856
Mailing Address - Fax:
Practice Address - Street 1:PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-0001
Practice Address - Country:US
Practice Address - Phone:571-231-2856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WRAMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN
OTH000Medicare UPIN