MALCOLM GROW MEDICAL CLINIC 779 MDG (NPI# 1518379395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518379395 |
| Entity Type | Organization |
| Organization Name | MALCOLM GROW MEDICAL CLINIC 779 MDG |
| Other Organization Name | DOD ANDREWS EPHCY |
| Practice Address |
1060 W Perimeter Rd Joint Base Andrews MD 20762-6602 |
| Mailing Address |
Malcolm Grow Medical Clinic 779 Mdg Mdss Sgsr 1060 W. Perimeter Rd Fb14 C/o Rmo Office Andrews Afb MD 20762-6600 |
| Practice Telephone | 2406122139 |
| Practice Fax Number | 2406123981 |
| Mailing Telephone | 2408574566 |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2016-09-01 |
| 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 | 2145938 | 01 |
| Other Name | Type Code |
|---|---|
| DoD ANDREWS ePhcy | Doing Business As Name - Organization |
| Street Address |
1060 W PERIMETER RD |
| City | JOINT BASE ANDREWS |
| State | MD |
| Zip Code | 20762-6602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982210423 | Kevin Wang | Dentist | 1057 W Perimeter Rd, Prince County, MD 20762 | 2020-09-21 |
| 1306467667 | Priscilla Andalia | Student in an Organized Health Care Education/Training Program | 1065 W. Perimeter Road, Jb Andrews, MD 20762 | 2020-04-28 |
| 1275162877 | Gabi Im | Dentist | 1065 W Perimeter Rd., Joint Base Andrews, Apo, AA 20762 | 2020-04-06 |
| 1083240139 | Shirley Ye | Student in an Organized Health Care Education/Training Program | 1025 Boston Rd, Joint Base Andrews, MD 20762 | 2020-03-20 |
| 1255988853 | Songxuan Zhou Niemtzow | Acupuncturist | Acupuncture Center and Integrative Medicine Center, 1060 West Perimeter Road, Joint Base Andrews, MD 20762 | 2019-08-20 |
| 1487010971 | Tracy Ellen Ambos | Social Worker | 5100 Fetcher Avenue, Joint Base Andrews, MD 20762 | 2016-01-13 |
| 1154718450 | Ryan Mason Kring | Emergency Medicine | Malcolm Grow Medical Clinics, 1060 W Perimeter Rd, Joint Base Andrews, MD 20762 | 2015-04-24 |
| 1518206044 | Jeremy Gallman | Veterinarian | 1781 Arnold Ave., Joint Base Andrews, MD 20762 | 2013-02-04 |
| 1043556418 | Kimberly Mccoy-singh | Physical Therapist | 1075 West Perimeter Rd., 779 Mdos/sgoy, Joint Base Andrews, MD 20762 | 2012-12-12 |
| 1417215799 | Alexander Rostam Kheradi | Emergency Medicine | 1050 West Perimeter Road, Joint Base Andrews, MD 20762 | 2012-04-24 |
| Find all providers in zip 20762 | ||||
| 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 |
|---|---|---|---|---|
| 1548868870 | Walter Reed National Military Medical Center | Military/U.S. Coast Guard Pharmacy | 101 Buchanan Rd, Annapolis, MD 21402-5107 | 2020-10-09 |
| 1184273195 | Naval Health Clinic Annapolis | Military/U.S. Coast Guard Pharmacy | 4141 W Wilson Rd Bldg 1600, Indian Head, MD 20640-5162 | 2019-09-11 |
| 1063763241 | National Naval Medical Center | Military/U.S. Coast Guard Pharmacy | 8901 Wisconsin Ave Dept Ofphcy, Bldg 9, Room 2303, Bethesda, MD 20889-0001 | 2012-09-27 |
| 1902905318 | Naval Health Clinic Patuxent River | Military/U.S. Coast Guard Pharmacy | Bldg 1370, Patuxent River, MD 20670 | 2006-09-22 |
| 1679672083 | Dunham Army Health Clinic | Military/U.S. Coast Guard Pharmacy | 1452 Porter St, Ft Detrick, MD 21702 | 2006-09-22 |
| 1851490270 | Malcom Grow Medical Center 79 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1050 W Perimeter Rd # D1119, Jb Andrews, MD 20762-6601 | 2006-09-22 |
| 1174620926 | Naval Health Clinic Patuxent River | Military/U.S. Coast Guard Pharmacy | Bldg 1600 Wilson Drive, Indian Head, MD 20640 | 2006-09-20 |
| 1265539019 | Malcom Grow Medical Center 79 Mdg Mdss Sgsr | Military/U.S. Coast Guard Pharmacy | 1 San Diego Loop Bldg 3188, Jb Andrews, MD 20762-5518 | 2006-09-20 |
| 1205242310 | Kimbrough Acc Military Mtf | Military/U.S. Coast Guard Pharmacy | 1434 Porter St, Frederick, MD 21702-9254 | 2014-07-09 |
| 1649682162 | Naval Health Clinic Annapolis | Military/U.S. Coast Guard Pharmacy | 695 Kinkaid Rd, Naval Health Clinic Annapolis, Annapolis, MD 21402 | 2014-06-02 |
| Find all providers with the same taxonomy | ||||
| City | JOINT BASE ANDREWS |
| Zip Code | 20762 |
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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.