Provider Demographics
NPI:1619168838
Name:SOUTHERN MARYLAND WOMEN'S HEALTHCARE, PA
Entity Type:Organization
Organization Name:SOUTHERN MARYLAND WOMEN'S HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:POOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-997-1788
Mailing Address - Street 1:41680 MISS BESSIE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2906
Mailing Address - Country:US
Mailing Address - Phone:301-997-1788
Mailing Address - Fax:301-997-1791
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2906
Practice Address - Country:US
Practice Address - Phone:301-997-1788
Practice Address - Fax:301-997-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD488MMedicare PIN