Provider Demographics
NPI:1205262771
Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANKFIELD-EDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-883-7868
Mailing Address - Street 1:1701 MCCORMICK DR STE 240
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:301-883-7868
Mailing Address - Fax:301-883-7891
Practice Address - Street 1:3003 HOSPITAL DR STE 1055
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1194
Practice Address - Country:US
Practice Address - Phone:301-583-3700
Practice Address - Fax:301-583-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD234843800Medicaid