Provider Demographics
NPI:1942288527
Name:MARY WASHINGTON HOSPITAL INC.
Entity Type:Organization
Organization Name:MARY WASHINGTON HOSPITAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-741-1414
Mailing Address - Street 1:2300 FALL HILL AVE
Mailing Address - Street 2:SUITE 509
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3342
Mailing Address - Country:US
Mailing Address - Phone:540-741-2277
Mailing Address - Fax:540-741-1097
Practice Address - Street 1:1001 SAM PERRY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4453
Practice Address - Country:US
Practice Address - Phone:540-741-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1874282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4900227Medicaid
VAHG2OtherCAREFIRST BC
VA148675200OtherDEPARTMENT OF LABOR
VA234771OtherUNITED HEALTHCARE HMO, ONENET, MDIPA, OPTIMUM CHOICE
VA000023OtherANTHEM BC
VA6560235OtherAETNA
VA0564123-038OtherCIGNA
VA234771OtherUNITED HEALTHCARE HMO, ONENET, MDIPA, OPTIMUM CHOICE
VA4900227Medicaid
VA490022Medicare ID - Type Unspecified
VA482821OtherHEALTHLINK
VA20031OtherCARENET M/K
VA4900227Medicaid