79TH MEDICAL GROUP MALCOLM GROW MEDICAL CENTER (NPI# 1972643401) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972643401 |
| Entity Type | Organization |
| Organization Name | 79TH MEDICAL GROUP MALCOLM GROW MEDICAL CENTER |
| Practice Address |
1050 W Perimeter Rd Malcolm Grow Medical Center Andrews Air Force Base MD 20762-6601 |
| Mailing Address |
11423 Plenty Gates Ct Waldorf MD 20601-5601 |
| Practice Telephone | 2408574951 |
| Practice Fax Number | 2408577138 |
| Mailing Telephone | 3016453357 |
| Mailing Fax Number | 2408577138 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-06-13 |
| Authorized Official Name | MS. NATALIE YVETTE GISCOMBE (ADULT NURSE PRACTITIONER) |
| Authorized Official Telephone | 2408574951 |
| Authorized Official Credential | REGISTERED NURSE |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 286500000X | Military Hospital | RN64518 | DC | Hospitals |
| Street Address |
1050 W PERIMETER RD MALCOLM GROW MEDICAL CENTER |
| City | ANDREWS AIR FORCE BASE |
| State | MD |
| Zip Code | 20762-6601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235542093 | Robert Smith | Military Health Care Provider | 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762-6601 | 2014-06-09 |
| 1316378896 | Teisha St. Rose | Nurse Anesthetist, Certified Registered | 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762-6601 | 2013-12-09 |
| 1255609624 | Us Air Force | Clinic/Center | 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762-6601 | 2011-12-13 |
| 1013298272 | Us Air Force | Military Hospital | 1050 W Perimeter Rd, Joint Base Andrews, Andrews Air Force Base, MD 20762-6601 | 2011-09-01 |
| 1265730394 | Matthew Robert Uber | Nurse Anesthetist, Certified Registered | 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762-6601 | 2011-03-15 |
| 1063748507 | Truong-vinh Phung | Pharmacist | 1050 W Perimeter Rd, Ste. E1-24, Andrews Air Force Base, MD 20762-6601 | 2009-10-18 |
| 1679712749 | Corazon Lego | Registered Nurse | 1050 W Perimeter Rd, Suite 1a-6, Andrews Air Force Base, MD 20762-6601 | 2009-02-13 |
| 1861655342 | Lynsey C Owen | Obstetrics & Gynecology | 1050 W Perimeter Rd, Andrews Air Force Base, MD 20762-6601 | 2008-07-06 |
| 1760693717 | Kathryn E Kanzler | Psychologist | 1050 W Perimeter Rd, 779 Mdos/sgow, Andrews Air Force Base, MD 20762-6601 | 2007-05-24 |
| 1346361052 | Elizabeth D Stewart | Internal Medicine | 1050 W Perimeter Rd, Andrews Afb, Andrews Air Force Base, MD 20762-6601 | 2007-04-02 |
| Find all providers in the same location | ||||
| 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 | 286500000X |
| Grouping | Hospitals |
| Classification | Military Hospital |
| A health care facility operated by the Department of Defense. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013298272 | Us Air Force | Military Hospital | 1050 W Perimeter Rd, Joint Base Andrews, Andrews Air Force Base, MD 20762-6601 | 2011-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205295193 | Salem Petros | Military Hospital | 12206 Castle Pines Dr, Beltsville, MD 20705-1146 | 2016-02-19 |
| 1275853251 | National Naval Medical Center | Military Hospital | 4400 E West Hwy Apt 1125, Bethesda, MD 20814-4513 | 2010-06-02 |
| 1326208661 | Christa M. Lewis | Military Hospital | 19419 Rayfield Dr, Germantown, MD 20874-6257 | 2008-06-10 |
| 1619011749 | Walter Reed Army Medical Center | Military Hospital | 2901 S. Leisure World Blvd. A-217, Silver Spring, MD 20906 | 2007-02-20 |
| 1164591822 | University of Texas Southwestern Medical Center | Military Hospital | National Cancer Institute Medical Oncology Branch, Building 10, Room 5a01, Bethesda, MD 20892-0001 | 2006-11-07 |
| 1730289133 | Kevin Charles Abbott | Military Hospital | 7 Rudis Way, Gaithersburg, MD 20878-1143 | 2006-09-25 |
| 1356317069 | National Naval Medical Center | Military Hospital | Professional Affairs, 8901 Wisconsin Ave, Bethesda, MD 20889-0001 | 2006-02-23 |
| 1992770879 | National Naval Medical Center | Military Hospital | 503 Robert Grant Avenue, Div Et, Walter Reed Army Institute of Research, Silver Spring, MD 20874 | 2006-02-22 |
| 1568437234 | Air Force Medical Operations Agency | Military Hospital | 525 Fraim Street, Afmoa/sgxs, Frederick, MD 21702 | 2006-02-17 |
| 1932185063 | United States Navy | Military Hospital | 6409 Trillium Trl, Glenn Dale, MD 20769-9034 | 2005-12-20 |
| Find all providers with the same taxonomy | ||||
| City | ANDREWS AIR FORCE BASE |
| Zip Code | 20762 |
Please comment or provide details below to improve the information on 79TH MEDICAL GROUP MALCOLM GROW MEDICAL CENTER.
| 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.