Provider Demographics
NPI:1669506317
Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Other - Org Name:MATERNAL HEALTH AND FAMILY PLANNING - LAUREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, CLIENT INFORMATION SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-883-7861
Mailing Address - Street 1:1701 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5329
Mailing Address - Country:US
Mailing Address - Phone:301-883-7861
Mailing Address - Fax:301-883-7890
Practice Address - Street 1:13976 BALTIMORE AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5086
Practice Address - Country:US
Practice Address - Phone:301-317-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD704431301Medicaid