WALTER REED NATIONAL MILITARY MED CENTER (NPI# 1093877086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093877086 |
| Entity Type | Organization |
| Organization Name | WALTER REED NATIONAL MILITARY MED CENTER |
| Other Organization Name | WOODBRIDGE NON-FORMULARY PHCY |
| Practice Address |
3700 Fettler Park Dr Dumfries VA 22025-2050 |
| Mailing Address |
9300 Dewitt Loop Fort Belvoir VA 22060-5285 |
| Practice Telephone | 7034917668 |
| Practice Fax Number | 7035507136 |
| Mailing Telephone | 5712312849 |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-03-18 |
| Authorized Official Name | HECTOR MORALES (CHIEF DHA PASS) |
| Authorized Official Telephone | 2105366650 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332000000X | Military/U.S. Coast Guard Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2105190 | 01 |
| Other Name | Type Code |
|---|---|
| WOODBRIDGE NON-FORMULARY PHCY | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326147463 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | Bmc Bldg 63, Sugar Grove, WV 26815 | 2006-09-22 |
| 1285733303 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 9501 Farrell Rd Bldg 808, Ft Belvoir, VA 22060-5901 | 2006-09-22 |
| 1649379363 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | Bldg 2 Rm 7817, Washington, DC 20012 | 2006-09-21 |
| 1194028407 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave, Bethesda, MD 20889-0001 | 2010-12-08 |
| 1114081866 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 450 Gibner Rd, Carlisle Barracks, PA 17013-5090 | 2006-12-20 |
| 1538221957 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave, Bethesda, MD 20889-0004 | 2006-12-14 |
| 1841352358 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave, Bethesda, MD 20889-0004 | 2006-12-14 |
| 1245392661 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave, Bethesda, MD 20889-0004 | 2006-12-14 |
| 1275695777 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave, Bethesda, MD 20889-0004 | 2006-12-14 |
| 1700948270 | Walter Reed National Military Med Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave, Bethesda, MD 20889-0004 | 2006-12-14 |
| Street Address |
3700 FETTLER PARK DR |
| City | DUMFRIES |
| State | VA |
| Zip Code | 22025-2050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316044175 | Fort Belvoir Community Hospital | Military/U.S. Coast Guard Pharmacy | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2006-09-20 |
| 1700402146 | Heather L. Bebout | Social Worker | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2020-06-22 |
| 1962903633 | Quynh-anh Rose | Pharmacist | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2018-02-27 |
| 1356874283 | Dewitt Army Community Hospital | Pharmacy | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2017-04-07 |
| 1023415825 | Fort Belvoir Community Hospital | Military/U.S. Coast Guard Pharmacy | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2014-11-24 |
| 1265707160 | Kenya Michelle Wade | Nurse Practitioner | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2012-03-12 |
| 1275843203 | Caitlin E Walker | Occupational Therapist | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2010-10-08 |
| 1265648935 | Kimberly Carter | Psychologist | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2007-05-16 |
| 1285849000 | Fort Belvoir Community Hospital | Clinic/Center | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2007-05-14 |
| 1093882268 | Beth Ann Herndon | Social Worker | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2006-11-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023622230 | Joanne Perdu-ouimet | Behavioral Analyst | Incredible Changes, 4191 Waterway Dr., Dumfries, VA 22025 | 2020-09-04 |
| 1194287524 | Above and Beyond Therapy LLC | Speech-Language Pathologist | 15389 Autum Ln, Dumfries, VA 22025 | 2019-04-04 |
| 1669954095 | Renee L Roberts | Registered Nurse | 4222 Fortuna Center Plaza Ste 280, Dumfries, VA 22025 | 2018-09-01 |
| 1689044869 | Tracy Agyeman-badu | Pharmacist | 4310 Fortuna Village Center Plaza, Dumfries, VA 22025 | 2015-10-01 |
| 1588054316 | Tiffany Washington | Pharmacy Technician | 16224 Taconic Cir, Dumfries, VA 22025 | 2015-02-02 |
| 1568706158 | Boulevard Center Pediatrics | Pediatrics | 3733 Fettler Park Dr., Dumfries, VA 22025 | 2012-11-20 |
| 1205111796 | Khanh T Le | Pharmacist | 17506 Cajun Ct, Dumfries, VA 22025 | 2011-10-15 |
| 1679737761 | Shailesh K Gohel | Pediatrics | 3733 Fettler Park Dr, Dumfries, VA 22025 | 2008-07-17 |
| 1376616268 | Douglas Kendrick Chan | Physical Therapist | 3767 Fettler Park Drive, Dumfries, VA 22025 | 2006-11-16 |
| 1861596454 | Paul Wells Conrad | Dentist | 16150 Country Club Drive, Dumfries, VA 22025 | 2006-09-12 |
| Find all providers in zip 22025 | ||||
| Taxonomy Code | 332000000X |
| Grouping | Suppliers |
| Classification | Military/U.S. Coast Guard Pharmacy |
| A Department of Defense (DoD) or U.S. Coast Guard entity whose primary function is to store, prepare and dispense pharmaceuticals and other associated items to Uniformed Services beneficiaries. These pharmacies may be associated with a DoD or U.S. Coast Guard clinic, DoD Hospital or freestanding. Usually associated with outpatient services. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: new; 7/1/2006: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316044175 | Fort Belvoir Community Hospital | Military/U.S. Coast Guard Pharmacy | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2006-09-20 |
| 1023415825 | Fort Belvoir Community Hospital | Military/U.S. Coast Guard Pharmacy | 3700 Fettler Park Dr, Dumfries, VA 22025-2050 | 2014-11-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174172183 | Naval Health Clinic Annapolis | Military/U.S. Coast Guard Pharmacy | 17457 Caffee Rd Bldg 192, Dahlgren, VA 22448-5120 | 2019-09-11 |
| 1114403961 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | 7021 Harbor View Blvd, Suffolk, VA 23435-2869 | 2018-07-16 |
| 1437563269 | Fort Belvoir Community Hospital | Military/U.S. Coast Guard Pharmacy | 8651 John J Kingman Rd, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060-6200 | 2014-06-19 |
| 1508270950 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | 1011 Eden Way N Ste H, Chesapeake, VA 23320-2768 | 2014-06-13 |
| 1205249059 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | 1647 Admiral Taussig Blvd Bldg Cd2, Norfolk, VA 23511-2803 | 2014-06-10 |
| 1467680819 | World Class Marketing Inc | Military/U.S. Coast Guard Pharmacy | 1814 Kecoughtan Rd, Suite B, Hampton, VA 23661-2834 | 2009-06-24 |
| 1609966936 | Naval Medical Center Portsmouth | Military/U.S. Coast Guard Pharmacy | Naval Weapons Station Yorktown, Bldg 1806, Yorktown, VA 23691-0090 | 2006-10-16 |
| 1982703013 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg 3219, Ft Lee, VA 23801 | 2006-09-22 |
| 1922107044 | Kenner Army Health Clinic | Military/U.S. Coast Guard Pharmacy | Bldg P8130, Ft Lee, VA 23801 | 2006-09-22 |
| 1659470771 | 1st Medical Group Sgsl | Military/U.S. Coast Guard Pharmacy | 65 Spaatz Dr, Langley Afb, VA 23665-2027 | 2006-09-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.