Provider Demographics
NPI:1639130222
Name:WALTER REED NATIONAL MILITARY MEDICAL CNTR
Entity type:Organization
Organization Name:WALTER REED NATIONAL MILITARY MEDICAL CNTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-295-1773
Mailing Address - Street 1:PSC BOX 509 CODE 6300
Mailing Address - Street 2:8901 WISCONSIN AVE
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5600
Mailing Address - Country:US
Mailing Address - Phone:301-295-4189
Mailing Address - Fax:301-319-8798
Practice Address - Street 1:PSC BOX 509 CODE 6300
Practice Address - Street 2:8901 WISCONSIN AVENUE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-4934
Practice Address - Fax:301-319-8798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER REED NATIONAL MILITARY MEDICAL CNTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD049005900Medicaid
MD049005900Medicaid