GARY A BYRUM (NPI# 1508161894) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508161894 |
| Entity Type | Individual |
| Full Name | GARY A BYRUM |
| Credential | IDC |
| Practice Address |
2008 Stump Neck Rd Naval Explosive Ordnance Disposal Technology Division Indian Head MD 20640-5070 |
| Mailing Address |
2008 Stump Neck Rd Naveodtecdiv Indian Head MD 20640-5070 |
| Practice Telephone | 7573752160 |
| Mailing Telephone | 7573752160 |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-01-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| Street Address |
2008 STUMP NECK RD NAVAL EXPLOSIVE ORDNANCE DISPOSAL TECHNOLOGY DIVISION |
| City | INDIAN HEAD |
| State | MD |
| Zip Code | 20640-5070 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851504237 | Dean Natale Del Favero | Military Health Care Provider | 2008 Stump Neck Rd, Indian Head, MD 20640-3681 | 2007-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639664683 | The Heard Group, LLC | Clinic/Center | 6284 Hard Bargain Cir, Indian Head, MD 20640 | 2018-06-22 |
| 1154790509 | Memuna Kamara | Nurse Practitioner | 319 Munahan Circle Unit A, Indian Head, MD 20640 | 2015-09-16 |
| 1174620926 | Naval Health Clinic Patuxent River | Military/U.S. Coast Guard Pharmacy | Bldg 1600 Wilson Drive, Indian Head, MD 20640 | 2006-09-20 |
| 1861494395 | Dale R Harman | Preventive Medicine | 1600 W Wilson Rd, Occupational Health Clinic, Nswc Indian Head, Indian Head, MD 20640-1400 | 2005-08-15 |
| 1467414508 | Keith Lynn Mayberry | Dentist | 1600 W Wilson Rd, Indian Head, MD 20640-1400 | 2006-04-04 |
| 1588646962 | John H Callahan | Physician Assistant | 17 Strauss Ave, Indian Head Division, Indian Head, MD 20640-1523 | 2005-11-18 |
| 1114064573 | Monica L Bilik | Physician Assistant | 101 Strauss Ave Bldg 901, Indian Head, MD 20640-1542 | 2007-02-01 |
| 1881654697 | Kevin F Kelley Sr. | Physician Assistant | 101 Strauss Ave, Cbirf, 2nd Mef, Indian Head, MD 20640-1542 | 2006-03-24 |
| 1750561189 | Dexter Arvange Woods | Dentist | 158 Riverwatch Dr, Indian Head, MD 20640-1558 | 2007-11-14 |
| 1649818907 | Augustina O Boadu | Non-emergency Medical Transport (VAN) | 32 Fairhill Ln, Indian Head, MD 20640-1577 | 2019-12-18 |
| Find all providers in zip 20640 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740693324 | Benjamin Graves | Military Health Care Provider | 3399 Strauss Ave Bldg 901, Indian Head, MD 20640-5164 | 2014-06-11 |
| 1497918635 | David Paul Horvath | Military Health Care Provider | 3399 Strauss Ave Ste 219, Indian Head, MD 20640-5164 | 2008-07-08 |
| 1932383593 | Michael A Walls | Military Health Care Provider | 3399 Strauss Ave, Suite 219, Indian Head, MD 20640-5164 | 2007-12-19 |
| 1851504237 | Dean Natale Del Favero | Military Health Care Provider | 2008 Stump Neck Rd, Indian Head, MD 20640-3681 | 2007-05-08 |
| 1003358573 | Timothy Andrew Wienke | Military Health Care Provider | 3399 Strauss Ave, Indian Head, MD 20640-5164 | 2016-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275143919 | Milton Mcintyre Brown Iv | Military Health Care Provider | 12610 Chanler Ln, Bowie, MD 20715-1302 | 2020-08-07 |
| 1548666415 | Janet Oliva | Military Health Care Provider | 6305 Riverdale Rd, Riverdale, MD 20737-2105 | 2014-11-05 |
| 1497009187 | Devin P Sweet | Military Health Care Provider | 5813 Chinquapin Pkwy, 1st Floor, Baltimore, MD 21239-2555 | 2012-11-01 |
| 1083980932 | Ernest Theophilus Quimby Iv | Military Health Care Provider | Walter Reed Nmmc, Bldg 1 Suite 5103 8955 Wood Road, Bethesda, MD 20889-5628 | 2012-03-26 |
| 1447557202 | Louis Florentine Gonzales | Military Health Care Provider | 28k Queen Mary Ct, Chester, MD 21619-2528 | 2011-02-14 |
| 1316147457 | Michael Waters | Military Health Care Provider | 14900 Park Central Road, Naval Support Facility, Thurmont, MD 21788 | 2007-07-18 |
| 1538362041 | Elizabeth Ann Davenport | Military Health Care Provider | 734 Carpenter Park Apt A, Patuxent River, MD 20670-1308 | 2007-06-11 |
| 1407067259 | Michael Bohdan Bozydaj | Military Health Care Provider | 14900 Park Central, Thurmont, MD 21788 | 2007-05-24 |
| 1649491721 | Ronald Thomas Kunz | Military Health Care Provider | 1681 Nelson St, Fort Detrick, MD 21702-9203 | 2007-05-02 |
| 1306814363 | Gregory John Peck | Military Health Care Provider | 13511 S Springfield Rd, Brandywine, MD 20613-9232 | 2006-03-08 |
| Find all providers with the same taxonomy | ||||
| City | INDIAN HEAD |
| Zip Code | 20640 |
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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.