Provider Demographics
NPI:1013192111
Name:GYNECOLOGY OF ST. MARY'S
Entity Type:Organization
Organization Name:GYNECOLOGY OF ST. MARY'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-475-2805
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0538
Mailing Address - Country:US
Mailing Address - Phone:301-475-2805
Mailing Address - Fax:301-475-7184
Practice Address - Street 1:41650 COURTHOUSE DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-475-2805
Practice Address - Fax:301-475-7184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35536207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD507MMedicare PIN