Provider Demographics
NPI:1093296576
Name:WASHINGTON COUNTY HEALTH DEPARTMENT-CSAP
Entity Type:Organization
Organization Name:WASHINGTON COUNTY HEALTH DEPARTMENT-CSAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARILYN
Authorized Official - Last Name:GAVIRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-313-3268
Mailing Address - Street 1:1302 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3108
Mailing Address - Country:US
Mailing Address - Phone:240-313-3491
Mailing Address - Fax:240-313-3341
Practice Address - Street 1:5980 CULLEN DR
Practice Address - Street 2:
Practice Address - City:SABILLASVILLE
Practice Address - State:MD
Practice Address - Zip Code:21780-9702
Practice Address - Country:US
Practice Address - Phone:240-420-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local