Provider Demographics
NPI:1760406110
Name:MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC
Entity Type:Organization
Organization Name:MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC
Other - Org Name:SMHC OBGYN SERVICES
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 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE 104A
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-868-8888
Practice Address - Fax:301-868-0409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD222101200Medicaid
B776OtherCAREFIRST NCA/MD
KR10MEOtherCAREFIRST NCA/MD
MD222101200Medicaid
B776OtherCAREFIRST NCA/MD
MD624316Medicare PIN