Provider Demographics
NPI:1881756435
Name:WALTER REED ARMY MEDICAL CENTER
Entity type:Organization
Organization Name:WALTER REED ARMY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC INFECTIOUS DISEASE FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:EBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-782-9774
Mailing Address - Street 1:WRAMC, BLDG 2, RM 2J38
Mailing Address - Street 2:6900 GEORGIA AVENUE, NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0001
Mailing Address - Country:US
Mailing Address - Phone:202-782-6248
Mailing Address - Fax:
Practice Address - Street 1:WRAMC, BLDG 2, DEPT OF PEDIATRICS
Practice Address - Street 2:6900 GEORGIA AVE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-6248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060903 A286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital