Provider Demographics
NPI:1629013552
Name:PATUXENT HOSPITALISTS LLC
Entity Type:Organization
Organization Name:PATUXENT HOSPITALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NYANJOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-997-5944
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-0244
Mailing Address - Country:US
Mailing Address - Phone:410-997-5944
Mailing Address - Fax:410-997-1720
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2912
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD148018Medicare PIN
DCG02355Medicare PIN