Provider Demographics
NPI:1508041559
Name:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:KEENA
Authorized Official - Last Name:LIPSCOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-717-7508
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE T4
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3527
Mailing Address - Country:US
Mailing Address - Phone:301-345-2463
Mailing Address - Fax:
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:SUITE NUMBER T4
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-345-2463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084686282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital