Organization
MEDSTAR GEORGETOWN MEDICAL CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE SCHNEIDER (VP)
(703) 558-1403
Entity
Organization
Contact information
Practice address
3800 RESERVOIR RD NW, WASHINGTON, DC 20007-2113
(888) 896-1400
Mailing address
PO BOX 418283, BOSTON, MA 02241-8283
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027174100
—
DC
05
—
097005100
—
MD
01
—
442AGE
BLUE SHIELD PEDS PCP GRP#
MD
01
—
6572
BLUE SHIELD GROUP NUMBER
DC
01
—
W675
BLUE SHIELD PEDS PCP GRP#
DC
01
—
W677
BLUE SHIELD ADULT PCP GRP
DC
Enumeration date
06/01/2005
Last updated
03/28/2024
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