Provider Demographics
NPI:1770554107
Name:US ARMY WALTER REED ARMY MED CTR
Entity type:Organization
Organization Name:US ARMY WALTER REED ARMY MED CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:210-274-9969
Mailing Address - Street 1:6900 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0003
Mailing Address - Country:US
Mailing Address - Phone:202-782-9511
Mailing Address - Fax:
Practice Address - Street 1:4601 N PARK AVE
Practice Address - Street 2:#1009
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4519
Practice Address - Country:US
Practice Address - Phone:301-656-1560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2865M2000X2865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital