Provider Demographics
NPI:1710978325
Name:PRINCEGEORGE'SCOUNTYHEALTHDEPTMENT
Entity Type:Organization
Organization Name:PRINCEGEORGE'SCOUNTYHEALTHDEPTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENTINFORMATIONSERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-883-7801
Mailing Address - Street 1:1701 MCCORMICK DR
Mailing Address - Street 2:3003HOSIPTALDRIVE
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5329
Mailing Address - Country:US
Mailing Address - Phone:301-883-7801
Mailing Address - Fax:301-883-7890
Practice Address - Street 1:3003 HOSPITAL DR
Practice Address - Street 2:1701MCCORMICKDRIVE
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1194
Practice Address - Country:US
Practice Address - Phone:301-883-7801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies