Provider Demographics
NPI:1881780211
Name:THE PHYSICIANS GROUP CHARTERED
Entity type:Organization
Organization Name:THE PHYSICIANS GROUP CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PIMENTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:301-638-0186
Mailing Address - Street 1:601 POST OFFICE RD
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1912
Mailing Address - Country:US
Mailing Address - Phone:301-638-0186
Mailing Address - Fax:301-843-6857
Practice Address - Street 1:601 POST OFFICE RD
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1912
Practice Address - Country:US
Practice Address - Phone:301-638-0186
Practice Address - Fax:301-843-6857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038147207R00000X
MDH0048020208000000X
MDH0042445207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD203631200Medicaid
DCG01177Medicare PIN
MD203631200Medicaid