| Organization Name: | MALCOLM GROW MEDICAL CENTER |
| NPI Number: | 1508917501 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNA M ERMOLD (STAFF PSYCHOLOGIST) |
| Mailing Address: | 1050 W Perimeter Rd 79mdos-sgohy Andrews Afb |
| State: | MD US |
| Postal Code: | 207626601 |
| Phone Number: | 2408570168 |
| Fax Number: | |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 286500000X |
| License Number: | 0810003522 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Military Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care facility operated by the Department of Defense. |