Provider Demographics
NPI:1366644197
Name:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Entity Type:Organization
Organization Name:MEDSTAR SOUTHERN MARYLAND PHYSICIANS, LLC
Other - Org Name:WOMEN'S HEALTH CENTER OF WALDORF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-856-3019
Mailing Address - Street 1:10403 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE G-04
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3134
Mailing Address - Country:US
Mailing Address - Phone:301-856-3019
Mailing Address - Fax:301-856-9370
Practice Address - Street 1:4225 ALTAMONT PL
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3063
Practice Address - Country:US
Practice Address - Phone:301-870-9900
Practice Address - Fax:301-870-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty