NPIMap

Organization Active NPI

Malcolm Grow Medical Center

  • Military Hospital
  • Andrews AFB, MD
National Provider Identifier
1508917501
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Military HospitalTaxonomy code 286500000X
License
0810003522 Issued in VA
Legal business name
MALCOLM GROW MEDICAL CENTER
Practice address
1050 W Perimeter Rd
79Mdos-Sgohy
Andrews AFB, MD 20762-6601
Phone
(240) 857-0168
NPI assigned
Jan 16, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jenna M Ermold, PH.D.NPI 1568516250
Title
Staff Psychologist
Phone
(240) 857-0168

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Military Hospital 286500000X 0810003522 VA Primary

Addresses

Primary practice location

1050 W Perimeter Rd
79Mdos-Sgohy
Andrews AFB, MD 20762-6601

Mailing address

1050 W Perimeter Rd
79Mdos-Sgohy
Andrews AFB, MD 20762-6601
Phone (240) 857-0168

National Provider Directory

National Provider Directory

Locations

1050 W Perimeter Rd
#79
Jb Andrews, MD 20762
Phone (240) 857-0168

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508917501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 W PERIMETER RD",
            "address_2": "79MDOS-SGOHY",
            "city": "ANDREWS AFB",
            "state": "MD",
            "postal_code": "207626601",
            "telephone_number": "240-857-0168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 W PERIMETER RD",
            "address_2": "79MDOS-SGOHY",
            "city": "ANDREWS AFB",
            "state": "MD",
            "postal_code": "207626601",
            "telephone_number": "240-857-0168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MALCOLM GROW MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ERMOLD",
        "authorized_official_first_name": "JENNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "STAFF PSYCHOLOGIST",
        "authorized_official_telephone_number": "240-857-0168",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "286500000X",
            "taxonomy_group": "",
            "desc": "Military Hospital",
            "state": "VA",
            "license": "0810003522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Andrews AFB, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.